GnRH agonists before surgery for uterine leiomyomas: A review

Pier Giorgio Crosignani, Paolo Vercellini, Michele Meschìa, Sabina Oldani, Tiziana Bramante

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To clarify whether preoperative treatment with gonadotropin- releasing hormone (GnRH) agonists offers substantial advantages to patients undergoing conservative or definitive surgery for uterine leiomyomas. STUDY DESIGN: A review of data from the most recent English-language literature. RESULTS: Inducing amenorrhea in patients with heavy menorrhagia and severe sideropenic anemia before both conservative and definitive surgery for uterine fibroids raises hemoglobin and hematocrit values to within the normal range, limits homologous blood transfusions and enables operations to be scheduled with the patients in better condition. A temporary 30-50% reduction in mean uterine volume theoretically may convert an abdominal into a vaginal hysterectomy in 'borderline' cases or sometimes allow a transverse instead of longitudinal abdominal incision. No trial has yet demonstrated 'clinically' significant reductions in operating time, operative blood loss or post- operative morbidity in patients undergoing myomectomy or hysterectomy after a course of GnRH agonists as compared with those operated on immediately. There seems insufficient scientific evidence to justify the routine use of GnRH agonists before myomectomy at laparotomy, except possibly in the case of extremely bulky uteri. GnRH agonist treatment before hysteroscopic myomectomy induces endometrial thinning, reduces bleeding and mucous debris, and decreases the diameter of submucous leiomyomas, improving visibility and limiting operating time and fluid intravasation. CONCLUSION: The available data seem to support the use of GnRH agonist treatment before surgery for uterine leiomyomas in selected circumstances. Administration of a GnRH agonist for only two or three months preoperatively seems to achieve all the advantages of this treatment, limiting side effects and cost.

Original languageEnglish
Pages (from-to)415-421
Number of pages7
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume41
Issue number6
Publication statusPublished - Jun 1996

Keywords

  • gonadotropin-releasing hormone
  • leiomyomas
  • uterine neoplasms

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine

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