Long‐term follow‐up of patients with uterine fibroids after treatment with the LHRH agonist buserelin

Abstract

Summary. Ten patients with uterine fibroids palpable abdominally were treated with the luteinizing hormone‐releasing hormone (LHRH) agonist buserelin, administered intransally, 300 μg three times daily, for 6 months, and were then followed for a further 12 months. Oestrogen levels were markedly reduced in all patients during treatment. At the end of treatment the mean volume reductions were 44·4% (SEM 3·5) for total uterine volume and 57·3% (SEM 7·4) for volume of discrete fibroids as assessed ultrasonically. There was also marked improvement in associated symptoms. After buserelin therapy was stopped, the total uterine and discrete fibroid volumes returned to, or slightly exceeded, pretreatment volumes within 6 months in five patients, and by 12 months in two patients. Three other patients who underwent surgery for their fibroids during the first 4 months after treatment showed regrowth of fibroids to pretreatment size, Four comparable asymptomtic untreated patients showed no significant change in the total uterine or fibroid volume during six monthly ultrasonic assessments. Buserelin therapy may facilitate rather than replace surgery in the management of uterine fibroids.

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

“…6 There is good evidence that pretreatment with GnRH analogues prior to hysterectomy or myomectomy for uterine fibroids will reduce both uterine volume and fibroid size and correct anaemia. 5,8,9 However, the published literature is by no means unanimous on their effect on operative blood loss. For instance, a recent randomized controlled trial could find no benefit when comparing depot triptorelin against no pre-treatment.…”

Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy

“…However, there is a risk of recurrence with myomectomy and the need for further surgery often arises 3,5 . Previous studies have demonstrated that gonadotrophin releasing hormone agonists (GnRHa) treatment can result in fibroid shrinkage of 30% to 60% 3,6,7 and gynaecologists have been encouraged to use the treatment 8,9 . A systematic review of 21 randomised controlled trials (RCTs) has reported that pre-operative treatment with GnRHa can lead to clinical benefits 5 .…”

Risk of Complications and Uterine Malignancies in Women Undergoing Hysterectomy for Presumed Benign Leiomyomas

“…However, alternatives to hysterectomy for symptomatic leiomyomas are becoming increasingly available. Gonadotropin-releasing-hormone (GnRH) agonists may be useful in perimenopausal women to control symptoms until menopause [1,2]. Furthermore, GnRH agonists combined with hormone-replacement therapy may be potential alternatives to hysterectomy performed for symptomatic leiomyomas [3,4].…”