DEPOT GOSERELIN AND DANAZOL PRETREATMENT BEFORE ROLLERBALL ENDOMETRIAL ABLATION FOR MENORRHAGIA

Objective: To compare the safety and efficacy of a GnRH agonist, depot goserelin, and danazol as preoperative treatments before rollerball e ndometrial ablation. Methods: We performed an open, randomized study o f women with clinically convincing histories of menorrhagia. Two treat ment groups of equal size (goserelin acetate, 3.6 mg subcutaneous impl ant given monthly, n = 30; and danazol, 200 mg two times per day, n = 30) were treated for 2 months before undergoing endometrial ablation, which entailed using the rollerball with 80-100 watts of coagulating c urrent. Results: Measured menstrual blood loss decreased dramatically after ablation, with 74% of goserelin users and 62% of danazol users a chieving complete amenorrhea by the end of the 6-month follow-up perio d. Among women who did not achieve complete amenorrhea, those in the d anazol group were more likely to experience occasional episodes of mod erate or heavy bleeding. Mean measured blood loss decreased from 94.8 to 1.1 mL at 3 months and 1.0 mL at 6 months after goserelin, and 97.9 to 15.0 mL and 7.4 mL after danazol. Menstrual pain also improved mar kedly. The median duration of surgery was 20 minutes (range 5-55) in b oth groups, median irrigation fluid deficit was 100 mL (range 0-800), and median operative blood loss was 20 mL (range 1-50). Endometrium wa s less than 2 mm thick in all goserelin and most danazol users. Side e ffects of goserelin and danazol therapy were all within the expected p attern for these drugs. Conclusion: Depot goserelin and danazol both p rovide adequate endometrial preparation before rollerball endometrial ablation for treatment of menorrhagia due to ovulatory dysfunctional u terine bleeding.