Gonadotropin releasing hormone agonist treatment before hysterectomy for menorrhagia and uterine leiomyomas.

OBJECTIVE

To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata-associated menorrhagia.

DESIGN

Prospective, comparative, nonrandomized study.

SETTING

A teaching hospital of Milano University.

PATIENTS

Anemic women requiring hysterectomy for myoma-associated menorrhagia.

INTERVENTION

Six months' preoperative goserelin treatment (41 cases) or immediate surgery (92 controls).

MAIN OUTCOME MEASURES

Abdominal/vaginal hysterectomy rate, number of transfusions, operating time, blood loss, complications, febrile morbidity, and days in hospital.

RESULTS

In the goserelin group mean hemoglobin rose (8.5 versus 13.3 g/dl) and mean uterine volume decreased (528 versus 251 ml). At preoperative pelvic exploration abdominal hysterectomy was indicated in 22 (54%) cases and 74 (80%) controls and vaginal hysterectomy in 19 (46%) and 18 (20%) (relative risk 3.6, 95% confidence interval 1.6 to 7.7; p = 0.001). No case required a transfusion whereas 51% of controls needed a total of 127 packed red cell units.

CONCLUSIONS

In anemic women with menorrhagia and leiomyomas, gonadotropin releasing hormone agonist treatment before hysterectomy limited transfusion requirements and increased the vaginal procedure rate.