USE OF TRANSVAGINAL ULTRASONOGRAPHY WITH COLOR DOPPLER IMAGING TO DETERMINE AN APPROPRIATE TREATMENT REGIMEN FOR UTERINE FIBROIDS WITH A GNRH AGONIST BEFORE SURGERY - A PRELIMINARY-STUDY

The aim was obtain data that could be used to determine the most appro priate treatment regimen for uterine fibroids with gonadotropin releas ing hormone analog (goserelin) before surgery. Fifteen premenopausal w omen (aged 27-53 years; mean 40 years) were referred from a gynecologi cal outpatients' clinic. They all had uterine fibroids and were schedu led to receive an implant of goserelin (3.6 mg), undergo transvaginal ultrasonography and have a sample of peripheral blood taken at monthly intervals for 6 months. The main outcome measures were fibroid size a nd indices of blood flow (the pulsatility index and peak systolic velo city) in both uterine arteries and the principal artery supplying the largest fibroid. The concentrations of follicle stimulating hormone, e stradiol, luteinizing hormone and progesterone were measured in periph eral plasma. Twelve women (80%) completed 2 months of treatment, but o nly three (20%) completed the study (due to side-effects of the drug). After 2 months of treatment, the plasma hormone levels were all in th e low-normal range; the mean fibroid volume had decreased by 53% and t he mean peak systolic blood velocity in the fibroid artery had decreas ed by 45%. Mean changes in all indices were < 10% over the next 4 mont hs of treatment. Six women (40%) had fibroids with an initial volume o f > 100 ml are the best candidates for treatment with goserelin (3.6 m g/month) before surgery. Two months' treatment effects a marked reduct ion in fibroid volume and blood flow and is associated with good compl iance.