GNRH AGONISTS AND UTERINE LEIOMYOMAS

Gonadotrophin-releasing hormone (GnRH) agonists are widely used in the treatment of women with symptomatic leiomyomas. The effectiveness of this treatment, as far as symptoms are concerned, is well established, and in recent years many studies have contributed to defining the opt imal role for GnRH agonists. Side-effects and health risks prohibit th e long-term use of these compounds. The combined use of high-dose agon ists and steroids in the so-called 'add back' schedules reduces many o f the disadvantages of the monotherapy. However, it is still an expens ive alternative when compared with definitive surgery, and therefore s hould only be used in women who insist on preservation of the uterus. Low-dose agonist therapy ('draw back') has not yet been proven to be s uitable for clinical application. The use of GnRH agonists and steroid s in sequential schedules seems to result in a loss of both the volume reduction as well as the reduction in clinical symptoms. The use of G nRH agonists prior to myoma surgery should not become a routine measur e and should be limited to cases where the size of the uterus is >600 ml. Hysterectomy should only be preceded by GnRH agonist treatment if uterine volume decrease is expected to facilitate either the abdominal or vaginal procedure. For both operative procedures the presence of m yoma-related anaemia is an indication for pretreatment. The use of GnR H agonists before endoscopic surgery is widely accepted on the basis o f assumptional advantages; however, definite proof of these advantages is not yet available.