Steroidal Treatment of Myomas: Preoperative and Long-Term Medical Therapy

Stewart, Elizabeth A.; Friedman, Andrew J.

doi:10.1055/s-2007-1018893

Cited by 42 publications

(18 citation statements)

References 71 publications

(115 reference statements)

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“…We used the last one, which, although subjective, is the most widely used in the literature studies that analyzed the LNG-IUS efficiency for treating heavy menstrual bleeding, therefore allowing us to compare our results with those from other authors. Initial studies demonstrated a sensitivity and specificity of >80% for a PBAC score of >100 [5]. On the other hand, Reid et al [18] have reported that there is no correlation between the observed PBAC and actual measured blood loss.…”

Section: Discussionmentioning

confidence: 96%

“…The second strategy for the management of leiomyomas is manipulation of the steroid hormone environment. The most widely used agent is gonadotrophin-releasing hormone agonist, but long-term therapy is prohibited because significant hypo-estrogenic effects on bone can lead to osteoporosis [5]. Other therapies include high-dose progestin therapy, danazol and gestrinone, and oral contraceptives to act on the endometrium to produce atrophy [6].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of heavy menstrual bleeding associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

et al. 2009

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Heavy menstrual bleeding is an increasingly common health problem. The levonorgestrel-releasing intrauterine system (LNG-IUS) has been advocated for the treatment of heavy menstrual bleeding as an alternative to surgery. Based on this established indication and theoretical potential of targeted endometrial solution of myoma-related bleeding, we evaluated the efficiency of LNG-IUS in treating selected cases presenting with heavy menstrual bleeding in the presence of uterine leiomyomas. This study included 68 patients with history of heavy menstrual bleeding and ultrasound-proved submucous uterine leiomyoma. Uterine bleeding was done by the semiquantitative pictorial blood loss assessment score. The 5-dimensional EuroQol was chosen as the primary measure of effectiveness on healthrelated quality of life. Patients were re-evaluated at 3, 6, 9, and 12 month. After 12 months of follow-up, a significant reduction of menstrual flow was observed up to amenorrhea (in 11 cases). No significant effect for the LNG-IUS on the volume of fibroids or the uterine volume was observed. A significant improvement of the quality of life (measured by EQ index) was observed. Side effects were reported in ten cases. Eight cases required removal of the IUS for different reasons. So this study shows that in selected cases of uterine leiomyomas, Mirena LNG-IUS is an effective therapy directed towards the local steroid environment of the endometrium for control of the bleeding with no valuable effect on the myomas themselves.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Treatment of heavy menstrual bleeding associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

et al. 2009

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“…Various authors have advocated a pre-treatment with GnRH analogues in order to induce amenorrhea and improve haemoglobin values in anaemic patients, as well as to reduce fibroids volume [10] and vascularization [11]. In facts, Vercellini et al demonstrated that a GnRH-a pre-treatment does not reduce blood loss during laparotomic myomectomies [12].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic myomectomy using endoscopic loops under progressive tension

Gambadauro¹,

Campo²,

Campo³

2010

Gynecol Surg

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The Authors describe a novel technique for laparoscopic myomectomy of fibroids with a subserosal component which involves the use of endoscopic loops under progressive tension to avoid bleeding, facilitate enucleation and possibly reduce the need of conventional sutures. Data analysis from a series of 34 consecutive operations shows that the use of endoloops helps achieving a good haemostasis, and no case of haemorrhage from the fibroid bed was ever recorded. Moreover, the need of diathermy was reduced, and the enucleation of the fibroids resulted facilitated by a bloodless field and the squeezing effect induced by the progressive tension on the loops. Although a reduction of number of traditional suturing was recorded, we do not recommend this technique to surgeons who are not familiar with conventional laparoscopic suturing. Overall, the suggested use of endoscopic loops seems to facilitate laparoscopic myomectomy on fibroids with at least a partial subserosal component. We believe that this method deserves comparative studies in order to furtherly demonstrate its safety and efficacy.

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“…This, in turn, produces a lowering of estradiol concentration, with resultant amenorrhea. This action has been utilized in the treatment of sex steroid-dependent diseases such as endometriosis and uterine leiomyoma [2,3]. However, treatment with GnRH-a is generally limited to a 6-month course because the long-term use of GnRH-a frequently causes unpleasant side effects associated with hypoestrogenism.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Every-Other-Day Administration of Conjugated Equine Estrogen and Medroxyprogesterone Acetate on Gonadotropin-Releasing Hormone Agonists Treatment in Women with Endometriosis

Irahara

Uemura

Kinoshita

et al. 2001

Gynecol Obstet Invest

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We performed a randomized controlled study to determine the efficacy of add-backed therapy by every-other-day administration of 0.625 mg conjugated equine estrogen (CEE) and 2.5 mg medroxyprogesterone acetate (MPA) on GnRH agonists (GnRH-a) treatment in Japanese women with symptomatic endometriosis. At the end of treatment, serum estrone and estradiol levels in the add-back group (n = 11) were significantly higher than those in the control group (n = 10). The assessment of Beecham classification by bimanual examination, serum CA-125 levels, and the frequency of genital bleeding revealed no significant differences between the two groups. The add-back group showed reduced Kupperman indices relative to those of the control group, and could prevent the loss of bone density. These findings led to a conclusion that GnRH-a therapy added back by every-other-day administration of 0.625 mg CEE and 2.5 mg MPA was a safe and effective treatment for Japanese women with endometriosis.

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Steroidal Treatment of Myomas: Preoperative and Long-Term Medical Therapy

Cited by 42 publications

References 71 publications

Treatment of heavy menstrual bleeding associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

Treatment of heavy menstrual bleeding associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

Laparoscopic myomectomy using endoscopic loops under progressive tension

Efficacy of Every-Other-Day Administration of Conjugated Equine Estrogen and Medroxyprogesterone Acetate on Gonadotropin-Releasing Hormone Agonists Treatment in Women with Endometriosis

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