TREATMENT WITH THE GONADOTROPIN-RELEASING HORMONE-AGONIST GOSERELIN BEFORE HYSTERECTOMY FOR UTERINE FIBROIDS

Objective To investigate the effect of the gonadotrophin releasing hormone (GnRH)-agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata, on the pre-operative symptoms, difficulty of operation and operative blood loss. Design Randomised placebo-controlled study. Setting Patients were recruited from the gynaecological outpatient departments from hospitals in Edinburgh, Glasgow and Newcastle. Subjects Seventy-one premenopausal women with uterine leiomyomata who were on the waiting list for hysterectomy. Interventions After the presence of leiomyomata was confirmed using ultrasonography, the women were randomised to receive either the GnRH-agonist goserelin by monthly subcutaneous injection or a sham injection for three months prior to operation. At the monthly visits, patients were asked about treatment related symptoms, fibroid related symptoms, and their bleeding patterns. Blood was taken for haematological assessment. Main outcome measures Haemoglobin concentrations at recruitment, at operation and postoperatively, pre-operative symptoms, operative difficulty and blood loss and post-operative complications. Results Treatment with goserelin induced amenorrhoea in over 80% of the women, and this was associated with a significant rise in haemoglobin level. At the time of operation, fibroid related symptoms were less in the goserelin group than in the placebo group. The hysterectomy was technically easier and the median (range) operative blood loss was significantly lower in the goserelin group compared with the placebo group (187(60-600)ml vs 308(118-1000)ml respectively; P < 0.05, Wilcoxon signed rank test). There was no difference between the two groups in the duration of hospital stay or the frequency of post-operative complications. The fibroids were smaller at the time of operation in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision. Conclusions This study demonstrates the benefits of goserelin in women having total abdominal hysterectomy for uterine leiomyomata.