Effects of the GnRH agonist therapy before laparoscopic myomectomy

Ko, Hyun Joo; Han, Sang Hoon; Hong, Joon Seok; Jeon, Yong Tark; Jee, Byung Chul; Park, Kyo Hoon; Suh, Chang Suk; Kim, Yong Beom

Abstract

OBJECTIVE
The aim of this study was to evaluate the effectiveness of GnRH agonist therapy prior to the planned myomectomy for the women who want to preserve their fertility.
METHODS
We reviewed 20 patients who had GnRH agonist therapy prior to the planned myomectomy from October 2003 to September 2004.
RESULTS
Mean age of the patients was 37.8+/-4.5 y and nulliparous women were 7 (35%) among 20. Average 3.05 (range 1-4) times of GnRH agonist injection was done prior to a surgery. Indications of myomectomy were menorrhagia (13/20, 65%), dysmenorrhea (7/20, 35%), and palpable pelvic mass (6/20, 30%). Average of the longest diameter of the largest myoma was 79.8 mm at first visit ultrasonography, and reduced to 60.8 mm after the completion of GnRH agonist treatment. This means that average 55.8% of volume reduction was achieved by GnRH agonist. Among 20 patients, 18 (90%) had laparoscopic myomectomy and 2 (10%) had laparotomy. Of the 2 patients who had laparotomy, one had severe adhesion caused by prior pelvic surgery and another had very large myoma which was refractory to the GnRH agonist therapy. The global mean operative time was 125+/-51 min. Average hemoglobin drop after operation was 1.6 g/dL and no patient had transfusion. Total hospital stay was 3.9+/-1.1 days for patients who had laparoscopic myomectomy and 8.5+/-2.1 days for patients who had laparotomy.
CONCLUSION
The use of GnRH agonist prior to the planned myomectomy was effective in reducing myoma volume and it enables surgeons to choose less invasive surgical approach.