Experience with a gonadotrophin-releasing hormone agonist prior to myomectomy – comparison of twice- vs thrice-monthly doses and a control group

Abstract

The aim of this randomised prospective study was to investigate the impact of preoperative gonadotrophin-releasing hormone agonist (GnRHa) compared with a control group with myomectomy. A total of 36 women (n = 36, group 1) with fibroids were randomised to receive either two monthly doses (n = 18/36, group 1a) or three monthly doses of goserelin (n = 18/36, group 1b) prior to myomectomy. The 32 women who received no treatment (group 2) comprised the controls. All patients had similar demographic features. There were no significant differences among the three groups with respect to: (1) mean intraoperative blood loss; (2) preoperative and postoperative blood transfusion or (3) length of hospital stay. The only advantage of administering GnRHa prior to myomectomy for symptomatic fibroids in our population was a higher haemoglobin level prior to surgery among the women who received three doses of the drug.

Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: A systematic review and meta-analysis

“…Detailed information for each included study on the different GnRHa preparations, their routes of administration or duration of treatment can be found in Table 1 . In two studies in the laparotomic group, comparisons were made between leuprolin 3.75mg, leuprolin 7.5mg and no pre-treatment [ 28 ] and between goserelin 3.6mg two doses every four weeks, goserelin 3.6mg three doses every four weeks and no pre-treatment [ 26 ]. We chose to use the data from the leuprolin 3.75 mg and two doses goserelin 3.6mg every four weeks, since these are more comparable to the other pre-treatment schedules in our analysis.…”

“…Only two studies reported on difficulty of the surgery (n = 147). A cohort study by Bassaw et al [ 26 ] assessed difficulty in enucleating the fibroids by asking surgeon whether the enucleation was considered difficult or not. No definition of ‘difficult’ was given.…”

A Multicenter Study Evaluating the Effect of Ulipristal Acetate during Myomectomy

“…For hysteroscopic myomectomies, surgeons evaluated hysteroscopic visualization (excellent [score = 3]; good [2]; or satisfactory, poor, or very poor [1]), relationship to the myometrium (well delineated [3]; well delineated in some areas, poor in others [2]; or poorly delineated throughout [1]), extrusion into the cavity during the procedure (yes [2] or no [1]), distension fluid deficit (<250 mL [3], 250-500 mL [2], or >500 mL [1]), estimated blood loss (<50 mL [3], 50-100 mL [2], or >100 mL [1]), and overall ease of the procedure compared with other similar cases (easier [3], routine [2], or more difficult [1]). The overall hysteroscopic surgical experience score was determined by summing the scores for each subscale for a total of 6 to 17, with higher scores indicating a better surgical experience.…”

“…The overall hysteroscopic surgical experience score was determined by summing the scores for each subscale for a total of 6 to 17, with higher scores indicating a better surgical experience. Similarly, for laparotomic/ laparoscopic myomectomies, surgeons evaluated ease of delineating surgical planes between the myoma and the myometrium (very easy [5], easy [4], routine [3], difficult [2], or extremely difficult [1]), ease of myoma separation from the surrounding myometrium (very easy [5], easy [4], routine [3], difficult [2], or extremely difficult [1]), estimated blood loss (<100 mL [4], 100-250 mL [3], 250-500 mL [2], or >500 mL [1]), and overall ease of the procedure compared with other similar cases (easier [6], routine [4], or more difficult [1]). The laparotomic/laparoscopic surgical experience score was calculated by summing the scores for each subscale for a total of 4 to 20, with higher scores indicating a better surgical experience.…”

“…Myomectomy is a viable treatment option for women experiencing myoma-related symptoms who desire uterine preservation or future fertility. Preoperative pharmacologic treatment may help facilitate myomectomy by shrinking myomas and resolving anemia, thereby leading to reduced postoperative complications, a lower operative time, and/or decreased intraoperative blood loss [1][2][3][4][5][6][7]. However, concern has been raised regarding the possibility that pharmacologic pretreatment may complicate surgery because of endometrial thickening [8][9][10], myoma migration [11,12], or changes in myoma texture and reduced differentiation from the surrounding endometrium/myometrium [13,14].…”