title: Single or repeated gonadotropin-releasing hormone agonist treatment avoids hysterectomy in premenopausal women with large symptomatic fibroids with no effects on sexual function.
abstract: OBJECTIVE
  The aim of our study was to explore the effects on symptoms and female sexual function of the medical management with gonadotropin-releasing hormone agonist (GnRHa) in women of more than 45 years old compared to surgical management.
  
  
  METHODS
  Women with symptomatic uterine fibroids were enrolled to participate to the present open-label study. We offered two different treatment options: medical with GnRHa for 6 months (group A) or hysterectomy (group B). The patients were reviewed in follow-up for 24 months. The impact of medical or surgical therapy on sexual life was evaluated.
  
  
  RESULTS
  No significant differences were found in population characteristics between the two groups. GnRHa treatment was efficient in reducing symptoms in 88% of patients but 22% of patients needed adjunctive cycles of medical therapy. After 24 months, 16% of the patients did not complete the study. The failure percentage of the medical treatment was 12%. No severe side-effects were recorded, and eight patients had reached menopause. No significant differences were observed in the Female Sexual Function Index score in each domain between the medical and surgical groups, with total scores of 18.94 ± 10.16 and 22.00 ± 8.86, respectively (mean ± standard deviation), and the prevalence of dysfunction was 12% and 22%, respectively, similar to the general population of the same age.
  
  
  CONCLUSIONS
  We found that medical therapy with GnRHa is a satisfactory alternative to surgery for fibroids in women of more than 45 years old.
authors.affiliation: Unit of Oncologic Gynaecology, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Anna Myriam
authors.initials: AM
authors.lastname: Perrone
authors.forename: Federica
authors.initials: F
authors.lastname: Pozzati
authors.forename: Barbara
authors.initials: B
authors.lastname: Di Marcoberardino
authors.forename: Martina
authors.initials: M
authors.lastname: Rossi
authors.forename: Martina
authors.initials: M
authors.lastname: Procaccini
authors.forename: Alice
authors.initials: A
authors.lastname: Pellegrini
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.forename: Pierandrea
authors.initials: P
authors.lastname: De Iaco
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007889:Leiomyoma / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D018231:Leiomyomatosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects; D017697:Premenopause; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000187:drug effects; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D047368:Tumor Burden / Q000187:drug effects; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014599:Uterus / Q000187:drug effects* / Q000473:pathology / Q000601:surgery
chemical_list: D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone
keywords: GnRHa; fibroids; medical treatment; peri-menopausal women; surgery