The efficacy of gonadotropin-releasing hormone agonist treatment before hysteroscopic myomectomy for large-sized submucosal leiomyoma

Abstract

To evaluate the efficacy and safety of a gonadotropin-releasing hormone (GnRH) agonist for treating large-sized submucosal leiomyoma before hysteroscopic myomectomy.The data were retrospectively collected from patients who underwent a hysteroscopic myomectomy for a submucosal leiomyoma >3.5 cm in size from January 2009 to December 2018. The patients were divided into the GnRH group and the control group according to whether they were pretreated before surgery.A total of 61 patients were included in the study, 31 in the GnRH agonist group and 30 in the control group. At diagnosis, the maximum leiomyoma diameter was similar between the 2 groups (4.67 ± 0.6 cm in the GnRH agonist group vs 3.82 ± 0.6 cm in the control group, P = .061). After pretreatment with the GnRH agonist, the maximum diameter was significantly smaller in the GnRH agonist group compared to the control group (3.82 ± 0.6 vs 4.33 ± 0.8 cm, respectively, P = .004). The leiomyoma volume in the GnRH agonist group decreased by 55.6%, from 41.68 ± 15.7 to 23.19 ± 10.4 cm 3 , which led to significant differences in leiomyoma volume between the 2 groups (23.19 ± 10.4 cm 3 in the GnRH agonist group vs 33.22 ± 24.7 cm 3 in the control group, P = .042). The GnRH agonist group showed a shorter operation time (37.7 vs 43.9 minutes, P = .040) and less uterine distention media was used (6800 vs 9373.3 mL, P = .037) compared to the control group. Postoperative complications such as estimated blood loss, remnant leiomyoma, and recurrence were similar between the 2 groups.Treatment with a GnRH agonist before hysteroscopic myomectomy for large submucosal leiomyoma might decrease the volume of the leiomyoma, reduce operation time, and the amount of uterine-distension media used without surgical complications.

Myomectomy in infertile women: More harm than good?

“…A systematic review of 26 randomized controlled trials confirmed the therapeutic benefits of GnRH-a before myomectomy (46). A reduction in fibroid size up to 55.6% has been reported in a recent study with subcutaneous injections of goserelin 3.75 mg administered twice before surgery at 4-week intervals (47). A crucial question so far unanswered is the effectiveness of shrinkage in the prevention or reduction of adhesion development.…”

Myomectomy for Infertility: Does it Do More Damage Than Good?

“…The therapeutic advantages of GnRH-a prior to myomectomy were validated by a comprehensive evaluation of 29 randomized controlled trials [46]. In a recent trial, goserelin 3.75mg subcutaneously given twice before surgery at intervals of 4 weeks led to a decrease in fibroids size up to 58.6% [47]. The effectiveness of shrinking in the prevention or decrease of adhesion formation is a critical subject that has not yet received satisfactory answers.…”