Does preoperative treatment with a gonadotropin-releasing hormone agonist improve the outcome of endometrial resection?

STUDY OBJECTIVE

To verify if more favorable long-term results of endometrial resection can be obtained with preoperative gonadotropin-releasing hormone (GnRH) agonist treatment.

DESIGN

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

SETTING

Tertiary care academic department.

PATIENTS

Sixty-three premenopausal women with established menorrhagia.

INTERVENTION

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

MEASUREMENTS AND MAIN 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.

CONCLUSION

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.