Gonadotropin-releasing hormone agonist treatment before abdominal myomectomy: a controlled trial

Objective: To ascertain whether adjuvant gonadotropin-releasing hormone (GnRH) agonist therapy decreases blood loss during abdominal myomectomy. Design: Randomized controlled trial. Setting: Academic reproductive surgery center. Patient(s): One hundred premenopausal women requiring first-line conservative surgery for symptomatic intramural or subserous fibroids. Intervention(s): Eight weeks of treatment with depot triptorelin before myomectomy or immediate surgery. Main Outcome Measure(s): Intraoperative blood loss, operating time, degree of difficulty of the procedure, and short-term rate of fibroid recurrence. Result(s): Mean (+/-SD) intraoperative blood loss was 265 +/- 181 mL in triptorelin recipients and 296 +/- 204 in patients who had immediate surgery (mean difference, -31 mL [95% Cl, -108 to 46 mL]). No significant differences were observed in blood loss according to uterine volume, number of fibroids removed, or total length of myometrial incisions. Most procedures in either group were of routine difficulty. On ultrasonography 6 months after myomectomy, four women in the GnRH agonist group and one in the immediate surgery group had tumor recurrence. Conclusion(s): Treatment with a GnRH agonist before abdominal myomectomy, has no significant effect on intraoperative blood loss. Thus, systematic use of medical therapy before abdominal myomectomy does not seem to be justified.