Gonadotropin releasing hormone agonist treatment before hysterectomy for menorrhagia and uterine leiomyomas

Objective. To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata-associated menorrhagia. Design. Prospective, comparative, nonrandomized study. Setting. A teaching hospital of Milano University. Patients. Anemic women requiring hysterectomy for myoma-associated menorrhagia. Intervention. Six months' preoperative goserelin treatment (41 cases) or immediate surgery (92 controls). Main outcome measures. Abdominal/vaginal hysterectomy rate, number of transfusions, operating time, blood loss, complications, febrile morbidity, and days in hospital. Results. In the goserelin group mean hemoglobin rose (8.5 versus 13.3 g/dl) and mean uterine volume decreased (528 versus 251 ml). At preoperative pelvic exploration abdominal hysterectomy was indicated in 22 (54%) cases and 74 (80%) controls and vaginal hysterectomy in 19 (46%) and 18 (20%) (relative risk 3.6, 95% confidence interval 1.6 to 7.7; p = 0.001). No case required a transfusion whereas 51% of controls needed a total of 127 packed red cell units. Conclusions. In anemic women with menorrhagia and leiomyomas, gonadotropin releasing hormone agonist treatment before hysterectomy limited transfusion requirements and increased the vaginal procedure rate.