Effect of a Single 3.75-mg Dose of Leuprolide Acetate for Preoperative Suppression before Endometrial Ablation
Twenty women planned for endometrial ablation were entered into a protocol administering leuprolide acetate 3.75 mg for preoperative suppression. The patients had an initial hysteroscopy and endometrial biopsy to ensure benign pathology and no demonstrable intrauterine lesions. A pretreatment transvaginal ultrasound was performed on the day of administration of leuprolide in the midluteul phase and then in 4 weeks, with endometrial ablation scheduled 5 to 6 weeks after the initial injection. In all but one woman, a single 3.75-mg dose resulted in an endometrial thickness of 4 mm or less, consistent with atrophic endometrium in menopausal patients. The exception was a patient weighing 265 lbs. An additional dose led to adequate suppression. Endometrial ablation was performed in all women with a continuous-flow resectoscope using both a rollerball and roller barrel. Distention was maintained with nonelectrolyte fluids, with average fluid deficit of 425 ml. No complications occurred. At the time of endometrial ablation, the endometrium was not as thinned-out or smooth as I found with a two-dose preoperative regimen of leuprolide. However, ultimate cure rates were comparable in the single-dose group, with amenorrhea 55% (11), hypomenorrhea or eumenorrhea 40% (8), and failed treatment 5% (1). A single dose of leuprolide acetate 3.75 mg results in adequate endometrial suppression, and clinical results are comparable with those of other pretreatment regimens.
Shwayder
JM
Eastern Virginia Medical School, 12720 McManus Blvd., #204, Newport News, VA 23602.