Benefit of GnRH Analogue Pretreatment for Hysteroscopic Surgery in Patients with Bleeding Disorders

Abstract

Hysteroscopic surgery is widely used for the treatment of patients suffering from menorrhagia. In different studies, pretreatment of the endometrium with GnRH analogues (GnRH-a) prior to endometrial ablation has been reported to increase the success rate, as well as to reduce the menstrual blood flow, accounting for a significantly higher postoperative amenorrhea rate (42% in pretreated patients vs. 24% in those receiving no pretreatment). The aim of pretreatment is not only to obtain a thin endometrium but also to reduce the size and vascularization of myomas being treated. In our study, GnRH-a administration prior to endometrial ablation was shown to have the following advantages: improved hysteroscopic view, reduced blood loss, absorption of uterine distending fluid and higher postoperative amenorrhea rates. Prior to hysteroscopic myoma resection, pretreatment with GnRH-a may be particularly indicated for all myomas with a diameter of more than 3 cm and/or with an intramural portion, or for patients suffering from secondary anemia. GnRH-a pretreatment is thus indicated before endometrial ablation, and in most cases, before hysteroscopic resection of submucous myomas, and combined medical and surgical therapy has clear benefits in the treatment of bleeding disorders.

A case of unsuspected leiomyosarcoma diagnosed following laparoscopy-assisted vaginal hysterectomy performed for presumed myoma after GnRH treatment

“…GnRH analogues or agonists can be used preoperatively for reducing the tumour size prior to hysteroscopic resection of predominantly submucous fibroids. Pretreatment with GnRH analogue may be particularly indicated for all myomas with a diameter of more than 3 cm and/or with an intramural portion, or for patients with secondary anaemia [10]. On the other hand, there are seldom reports showing that these medications may also lead to substantial degeneration and infarction of the leiomyoma, making the preoperative diagnosis of leiomyosarcomas even more difficult [11,12].…”

The safety and efficacy of microwave endometrial ablation

“…Предоперационная подготовка эндометрия аналогами ГнРГ или даназолом имеет следующие преимущества: улучшение условий для визуализации полости матки, уменьшение потери крови, а также большую частоту послеоперационной аменореи [14]. Последнее преимущество, вероятно, связано с тем, что соответствующие гормональные препараты оказывают желаемый эффект на всем протяжении эндометрия, в то время как при выскабливании на этапе подготовки к МАЭ можно неадекватно удалить эндометрий, особенно в трубных углах.…”

Analogues de la GnRH et myomes : plutôt contre, mais...

“…Römer [12] montre une diminution de la durée opéra-toire si le fibrome est de taille inférieure à 3 cm, une diminution des pertes sanguines peropératoires avec une meilleure visualisation du geste, une diminution des complications à type de perforation, une facilité d'organisation, la date opératoire pouvant être fixée indépendamment des règles, et comparée à un traitement par voie orale, une observance supérieure.…”