Does preoperative treatment with a gonadotropin-releasing hormone agonist improve the outcome of endometrial resection?
OBJECTIVE
To verify if more favorable long-term results of endometrial resection can be obtained with preoperative gonadotropin-releasing hormone (GnRH) agonist treatment.


METHODS
Multicenter, randomized, controlled trial (Canadian Task Force classification I).


METHODS
Tertiary care academic department.


METHODS
Sixty-three premenopausal women with established menorrhagia.


METHODS
Eight weeks of goserelin depot treatment before endometrial resection or immediate surgery in the early proliferative phase of the cycle.


RESULTS
Variations in menstrual patterns and bleeding scores as well as overall degree of satisfaction with treatment were determined 1 year after endometrial resection. Mean +/- SD monthly pictorial blood loss-assessment chart scores in the second 6-month follow-up period were 26.9 +/- 31.6 in the goserelin group and 44.0 +/- 45.7 in the immediate surgery group (mean difference 17.1 points, 95% CI -3.0 to +37.2, p = 0.09, unpaired t test). Respective amenorrhea rates were 34% (11/32) and 20% (6/20, p = 0.26, Fisher's exact test, 95% CI of difference -8% to +37%). Overall satisfaction with treatment was 91% and 87%, respectively.


CONCLUSIONS
Administration of a GnRH agonist before endometrial resection is advantageous for surgery, but has a limited effect in terms of postoperative bleeding pattern and appears not to offer clear-cut long-term clinical benefit.
Clinica Ostetrica e Ginecologica "Luigi Mangiagalli," Universita di Milano, Via Commenda, 12, 20122 Milan, Italy.
P
P
Vercellin
A
A
Perin
R
R
Consonn
S
S
Oldan
F
F
Parazzini
P G
PG
Crosignani
D018194:Adenomyoma / Q000150:complications / Q000601:surgery; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004564:Electrocoagulation / Q000379:methods; D004717:Endometrium / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D017273:Goserelin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000601:surgery
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D017273:Goserelin