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

Objective To investigate the effect of the gonadotrophin releasing hor mone (GnRH)-agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine le iomyomata, on the pre-operative symptoms, difficulty of operation and operative blood loss. Design Randomised placebo-controlled study. Sett ing Patients were recruited from the gynaecological outpatient departm ents from hospitals in Edinburgh, Glasgow and Newcastle. Subjects Seve nty-one premenopausal women with uterine leiomyomata who were on the w aiting list for hysterectomy. Interventions After the presence of leio myomata 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 sympto ms, fibroid related symptoms, and their bleeding patterns. Blood was t aken for haematological assessment. Main outcome measures Haemoglobin concentrations at recruitment, at operation and postoperatively, pre-o perative symptoms, operative difficulty and blood loss and post-operat ive complications. Results Treatment with goserelin induced amenorrhoe a 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. T he hysterectomy was technically easier and the median (range) operativ e blood loss was significantly lower in the goserelin group compared w ith 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 po st-operative complications. The fibroids were smaller at the time of o peration in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision. Con clusions This study demonstrates the benefits of goserelin in women ha ving total abdominal hysterectomy for uterine leiomyomata.