title: Three-month treatment with triptorelin, letrozole and ulipristal acetate before hysteroscopic resection of uterine myomas: prospective comparative pilot study.
abstract: OBJECTIVE
  To compare the usefulness of preoperative treatment with triptorelin, letrozole or ulipristal acetate or no treatment before hysteroscopic removal of uterine submucosal myomas.
  
  
  METHODS
  Single center prospective non-randomized comparative pilot study. The study included consecutive premenopausal patients undergoing hysteroscopic resection of myomas graded as type 0, type 1 or type 2 according to the FIGO classification with diameter between 20 and 35 mm. Exclusion criteria were: associated polyps, associated non-hysteroscopic surgical procedures, >2 myomas requiring hysteroscopic resection. This study enrolled patients who underwent either direct surgery (group S; n=23) or 3-month preoperative treatment with triptorelin (3.75 mg every 28 days; group T; n=20), letrozole (2.5 mg/day; group L; n=11) or ulipristal acetate (5 mg/day; group U; n=7). Patients underwent hysteroscopic resection of the myomas.
  
  
  RESULTS
  All medical treatments caused a significant decrease in the volume of myomas (group T, p<.001; group L, p<.001; group U, p=.006); however, the percentage decrease in myoma volume was lower in group U than in group T (p=.001) and in group L (p=.010). The hysteroscopy time was higher in group S than in group T (p<.001) and in group L (p=.001); there was no significant difference in the hysteroscopy time between group S and group U (p=.206). Fluid absorption was lower in group T than in group S (p=.002) and in group L than in group S (p=.048); fluid absorption was similar in group S and group U (p=.110). Intra- and postoperative complications, postoperative pain, and patient satisfaction were similar in the four study groups. Surgeon's evaluation of operative difficulty was better in group T than in group S (p<.005).
  
  
  CONCLUSIONS
  Preoperative treatment with triptorelin and letrozole decreases the hysteroscopy time and the volume of fluid absorbed during hysteroscopic resection of uterine submucosal myomas.
authors.affiliation: Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Bizzarri
authors.affiliation: Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ghirardi
authors.affiliation: Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Remorgida
authors.affiliation: Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Venturini
authors.affiliation: Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy. Electronic address: simone.ferrero@unige.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003270:Contraceptive Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D007889:Leiomyoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000077289:Letrozole; D009570:Nitriles / Q000627:therapeutic use*; D009649:Norpregnadienes / Q000627:therapeutic use*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D014230:Triazoles / Q000627:therapeutic use*; D017329:Triptorelin Pamoate / Q000627:therapeutic use*; D047368:Tumor Burden / Q000187:drug effects*; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D003270:Contraceptive Agents; D009570:Nitriles; D009649:Norpregnadienes; D014230:Triazoles; D017329:Triptorelin Pamoate; D000077289:Letrozole; C555622:ulipristal acetate
keywords: GnRH analog therapy; Hysteroscopy; Letrozole; Myomectomy; Submucous fibroid; Triptorelin