Treatment with a gonadotrophin releasing hormone agonist before hysterectomy for leiomyomas: results of a multicentre, randomised controlled trial.
OBJECTIVE
To ascertain whether uterine shrinkage induced by a gonadotrophin releasing hormone agonist before hysterectomy for fibroids increases the possibility of a vaginal procedure.


METHODS
A multicentre, prospective, randomised, controlled study.


METHODS
One hundred and twenty-seven premenopausal women with a uterine volume of 12 to 16 gestational weeks.


METHODS
Twelve weeks of triptorelin depot treatment before hysterectomy or immediate surgery.


METHODS
Number of vaginal and abdominal hysterectomies, operating time, blood loss, degree of difficulty of the procedure, perioperative serum haemoglobin and haematocrit levels, hospital stay, and patients' overall satisfaction with treatment.


RESULTS
After randomisation, four women withdrew from the study, leaving 60 women in the triptorelin arm and 63 in the immediate surgery arm. At baseline evaluation a vaginal hysterectomy was indicated in seven women allocated to pre-operative medical therapy (12%), and in 10 of those allocated to immediate surgery (16%). Clinical assessment after the 12-week GnRH agonist course showed that abdominal hysterectomy was no longer indicated in 25/53 women (47%) as a vaginal procedure appeared appropriate. Thus the overall rate of indication for a vaginal procedure in the pre-operative medical treatment arm was 32/60 cases (53%), with a between-group difference of 37% (95% CI, 26% to 51%; chi2(1) = 19.18, P < 0.0001; OR 6.06; 95% CI, 2.60 to 14.10). Pre- and post-operative serum haemoglobin and haematocrit levels were significantly higher in the GnRH agonist than in the immediate surgery arm. No appreciable difference was observed between the groups in the other intra- and post-operative variables, including patients' satisfaction.


CONCLUSIONS
Pre-operative GnRH agonist therapy increased the rate of vaginal hysterectomy in selected women with fibroids and uterine volume of 12 to 16 gestational weeks.
Vercellini
P
P
First Department of Obstetrics and Gynaecology, University of Milano, Italy.
Crosignani
P G
PG
Mangioni
C
C
Imparato
E
E
Ferrari
A
A
De Giorgi
O
O
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D018231:Leiomyomatosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000627:therapeutic use*; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D017329:Triptorelin Pamoate