Does preoperative treatment with a gonadotropin-releasing hormone agonist improve the outcome of endometrial resection?

Abstract

Study objective: To verify if more favorable long-term results of endometrial resection can be obtained with preoperative gonadotropin-releasing hormone (GnRH) agonist treatment.

Design: Multicenter, randomized, controlled trial (Canadian Task Force classification I).

Setting: Tertiary care academic department.

Patients: Sixty-three premenopausal women with established menorrhagia.

Intervention: Eight weeks of goserelin depot treatment before endometrial resection or immediate surgery in the early proliferative phase of the cycle.

Measurements and main results: Variations in menstrual patterns and bleeding scores as well as overall degree of satisfaction with treatment were determined 1 year after endometrial resection. Mean +/- SD monthly pictorial blood loss-assessment chart scores in the second 6-month follow-up period were 26.9 +/- 31.6 in the goserelin group and 44.0 +/- 45.7 in the immediate surgery group (mean difference 17.1 points, 95% CI -3.0 to +37.2, p = 0.09, unpaired t test). Respective amenorrhea rates were 34% (11/32) and 20% (6/20, p = 0.26, Fisher's exact test, 95% CI of difference -8% to +37%). Overall satisfaction with treatment was 91% and 87%, respectively.

Conclusion: Administration of a GnRH agonist before endometrial resection is advantageous for surgery, but has a limited effect in terms of postoperative bleeding pattern and appears not to offer clear-cut long-term clinical benefit.