Pre- and postoperative therapy with GnRH agonist for endometrial resection. A prospective, randomized study

Abstract

Background. To assess the value of endometrial preparation, with preoperative and pre- and postoperative GnRH agonist therapy in transcervical endometrial resection. Methods. Sixty women with menorrhagia were randomly divided between three groups: A: no preoperative preparation, B: goserelin 3.6 mg given as a subcutaneous implant 4-6 weeks preoperatively, and C: the same regimen as B, and repeated on the day of endometrial resection. At follow-up visits 1, 3, 6 and 12 months after operations the patients were interviewed for duration, amount and pains of menstrual periods. Results. The duration of surgery for the pretreated group (32.8 ± 5.1 min) and the group treated postoperatively (30.9 ± 8.9 min) were significantly shorter than that in the control group (46.4 ± 11.5 min) (p < 0.01). The weight of endomyometrial strips was about 3 times lower for group B and C as compared to group A (p < 0.01). Three months following the procedure twenty five percent of patients in group A were amenorrheic or showed scanty bleeding as compared to 58% and 85% in group B and C (p < 0.05 and p < 0.01), respectively. At 12 months follow-up these rates were 35%, 58% and 67% respectively (A versus B: NS, A versus C: p < 0.05) and 24%, 65% and 75% after excluding larger submucosal fibroids (A versus B: p < 0.025, A versus C: p < 0.005). No statistical difference was demonstrated between group B and C. Sixty-nine percent of pretreated patients (group B + C) versus 35% of women in group A reported improved or relieved menstrual cramps (p < 0.05). Conclusions. GnRH pretreatment facilitates endometrial resection and increases the rate of amenorrhea and scanty bleeding postoperatively. Whether supplementary postoperative therapy with GnRH agonist enhances the success rate further is uncertain.