BENEFIT OF GNRH ANALOG PRETREATMENT FOR HYSTEROSCOPIC SURGERY IN PATIENTS WITH BLEEDING DISORDERS

Hysteroscopic surgery is widely used for the treatment of patients suf fering from menorrhagia. In different studies, pretreatment of the end ometrium with GnRH analogues (GnRH-a) prior to endometrial ablation ha s been reported to increase the success rate, as well as to reduce the menstrual blood flow, accounting for a significantly higher postopera tive amenorrhea rate (42% in pretreated patients vs. 24% in those rece iving no pretreatment). The aim of pretreatment is not only to obtain a thin endometrium but also to reduce the size and vascularization of myomas being treated. In our study, GnRH-a administration prior to end ometrial ablation was shown to have the following advantages: improved hysteroscopic view, reduced blood Loss, absorption of uterine distend ing fluid and higher postoperative amenorrhea rates. Prior to hysteros copic myoma resection, pretreatment with GnRH-a may be particularly in dicated for all myomas with a diameter of more than 3 cm and/or with a n intramural portion, or for patients suffering from secondary anemia. GnRH-a pretreatment is thus indicated before endometrial ablation, an d in most cases, before hysteroscopic resection of submucous myomas, a nd combined medical and surgical therapy has clear benefits in the tre atment of bleeding disorders.