The Place of Zoladex&amp;reg; in Deferred Surgery for Uterine Fibroids

Gerris, Jan; Degueldre, Michel; Peters, A. C. B.; Romão, Fátima; Stjernquist, Martin; Al-Taher, Homood

doi:10.1159/000184806

Cited by 23 publications

(10 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unspecified size (GnRH vs no pre-Rx) Audebert, 1994Balasch,1995Bustos Lopez, 1995Cagnacci, 1994Fedele, 1990Gerris, 1996Golan, 1993Nikolov, 1997Vercellini, 1998Zollo, 1996 Subtotal ( 1 days [-1.2, -0 Fig. 3.…”

Section: Study Wmd (95% CI Fixed)mentioning

confidence: 99%

“…GnRH vs no pre-Rx Balasch, 1995Gerris, 1996 GnRH vs placebo Lumsden, 1994Shaw, 1996 Subtotal (95% CI) -0.01 -0. post-operative recurrence of myomas did not differ significantly between treatment groups in one small placebocontrolled trial but significant differences were found in the trials with no pretreatment. There was little heterogeneity in the no pretreatment trials assessing blood loss and a strong trend in favour of GnRHa in the placebo-controlled trials so it is likely that the overall result is valid.…”

Section: Study Peto or (95% CI Fixed)mentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of pre‐operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review

Lethaby

Vollenhoven

Sowter³

2002

BJOG

186

View full text Add to dashboard Cite

The use of GnRHa for three to four months prior to fibroid surgery reduces both uterine volume and fibroid size. They are beneficial in the correction of pre-operative iron deficiency anaemia, if present, and reduce intra-operative blood loss. If uterine size is such that a midline incision is planned, this can be avoided in many women with the use of GnRHa. For women undergoing hysterectomy, a vaginal procedure is more likely following the use of these agents.

show abstract

Section: Study Wmd (95% CI Fixed)mentioning

confidence: 99%

Section: Study Peto or (95% CI Fixed)mentioning

confidence: 99%

Efficacy of pre‐operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review

Lethaby

Vollenhoven

Sowter³

2002

BJOG

186

View full text Add to dashboard Cite

show abstract

“…GnRH vs no pre-Rx Balasch, 1995Gerris, 1996 GnRH vs placebo Lumsden, 1994Shaw, 1996 Subtotal (95% CI) post-operative recurrence of myomas did not differ significantly between treatment groups in one small placebocontrolled trial but significant differences were found in the trials with no pretreatment. There was little heterogeneity in the no pretreatment trials assessing blood loss and a strong trend in favour of GnRHa in the placebo-controlled trials so it is likely that the overall result is valid.…”

Section: Study Peto or (95% CI Fixed)mentioning

confidence: 99%

Section: Study Wmd (95% CI Fixed)mentioning

confidence: 99%

Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review

Lethaby

2002

BJOG: An International Journal of Obstetrics and Gynaecology

117

View full text Add to dashboard Cite

Objective To evaluate the role of pretreatment with gonadotrophin releasing hormone (GnRH) analogues (GnRHa) prior to surgery for women with uterine fibroids. Design A systematic review was undertaken of all randomised controlled trials assessing the efficacy of GnRHa treatment prior to surgery (myomectomy or hysterectomy) in women with fibroids. Setting Secondary care.Sample Premenopausal women with fibroids awaiting surgery attending hospitals or clinics.Methods Electronic searches of Medline, EmBase, Current Contents, the Cochrane Library, NationalResearch Register, NLM's Clinical Trials Register and the Cochrane group's Trials Register were performed, between 1980 and 2000. Twenty-six randomised controlled trials were identified that compared GnRHa with no treatment, placebo or other medical treatment. The quality of the trials was assessed and data were extracted independently by two of the reviewers. Statistical analysis was performed in Revman according to Cochrane guidelines and where possible outcomes were pooled in a meta-analysis. Main outcome measures Pre-operative assessment (reduction in uterine and fibroid volume, change in haemoglobin and haematocrit, change in patient's symptoms), intra-operative assessment (duration of operation, blood loss, proportion with vertical incision, proportion undergoing vaginal rather than abdominal procedure, frequency of blood transfusions), post-operative assessment (complications, duration of hospital stay, recurrence of fibroids). Results Pre-and post-operative haemoglobin and haematocrit were significantly improved by GnRHa therapy prior to surgery, and uterine volume, uterine gestational size and fibroid volume were all reduced. Pelvic symptoms were also reduced but some adverse events were more likely during GnRHa therapy. Hysterectomy appeared to be easier after pretreatment with GnRHa therapy; there was reduced operating time and a greater proportion of hysterectomy patients was able to have a vaginal rather than an abdominal procedure. Duration of hospital stay was also reduced. Blood loss and rate of vertical incisions were reduced for both myomectomy and hysterectomy. Evidence of increased risk of fibroid recurrence after GnRHa pretreatment in myomectomy patients was equivocal and few data were available to assess change in postoperative fertility. Conclusions The use of GnRHa for three to four months prior to fibroid surgery reduces both uterine volume and fibroid size. They are beneficial in the correction of pre-operative iron deficiency anaemia, if present, and reduce intra-operative blood loss. If uterine size is such that a midline incision is planned, this can be avoided in many women with the use of GnRHa. For women undergoing hysterectomy, a vaginal procedure is more likely following the use of these agents.

show abstract

“…Although the gonadotrophin releasing hormone agonists aremore frequently used in assisted conception, in the management of endometriosis, for the premenstrual syndrome, and to prepare the endometrium before hysteroscopic surgery, they have also been shown to reduce the size of fibroids by up to 50% with short term treatment (3-6 months) This has made them an ideal adjunct to surgery for large symptomatic fibroids 29. The main disadvantages of gonadotrophin releasing hormone agonists are secondary to the induced hypo-oestrogenic state, affecting the cardiovascular, skeletal, and urogenital systems and producing vasomotor symptoms.…”

Section: Gonadotrophin Releasing Hormone Agonistsmentioning

confidence: 99%