Pre- and postoperative therapy with GnRH agonist for endometrial resection. A prospective, randomized study.
BACKGROUND
To assess the value of endometrial preparation, with preoperative and pre- and postoperative GnRH agonist therapy in transcervical endometrial resection.


METHODS
Sixty women with menorrhagia were randomly divided between three groups: A: no preoperative preparation, B: goserelin 3.6 mg given as a subcutaneous implant 4-6 weeks preoperatively, and C: the same regimen as B, and repeated on the day of endometrial resection. At follow-up visits 1, 3, 6 and 12 months after operations the patients were interviewed for duration, amount and pains of menstrual periods.


RESULTS
The duration of surgery for the pretreated group (32.8 +/- 5.1 min) and the group treated postoperatively (30.9 +/- 8.9 min) were significantly shorter than that in the control group (46.4 +/- 11.5 min) (p < 0.01). The weight of endomyometrial strips was about 3 times lower for group B and C as compared to group A (p < 0.01). Three months following the procedure twenty five percent of patients in group A were amenorrheic or showed scanty bleeding as compared to 58% and 85% in group B and C (p < 0.05 and p < 0.01), respectively. At 12 months follow-up these rates were 35%, 58% and 67% respectively (A versus B: NS, A versus C: p < 0.05) and 24%, 65% and 75% after excluding larger submucosal fibroids (A versus B: p < 0.025, A versus C: p < 0.005). No statistical difference was demonstrated between group B and C. Sixty-nine percent of pretreated patients (group B + C) versus 35% of women in group A reported improved or relieved menstrual cramps (p < 0.05).


CONCLUSIONS
GnRH pretreatment facilitates endometrial resection and increases the rate of amenorrhea and scanty bleeding postoperatively. Whether supplementary postoperative therapy with GnRH agonist enhances the success rate further is uncertain.
Sørensen
S S
SS
Department of Obstetrics and Gynecology, KAS-Glostrup, University Hospital of Copenhagen, Denmark.
Colov
N P
NP
Vejerslev
L O
LO
D000328:Adult; D004717:Endometrium / Q000601:surgery*; D005260:Female; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care
D017273:Goserelin