April - June 2012, Volume 8, Issue 2

Ursuleanu A, Nicodin O, Gussi I, Niculescu N, Costachescu G

Triptorelin Modulation of Gonadal Steroidogenesis as a Preoperative Treatment in Leiomyomata Uteri

Acta Endo (Buc) 2012, 8 (2): 231-238
doi: 10.4183/aeb.2012.231

Introduction. The gold standard for surgery of fibroids is vaginal surgery and a preoperative treatment that facilitates this approach through reduction of the uterine\r\nvolume is of utmost importance. GnRH agonists and selective progesterone receptor modulators (SPRM) have both been tested to this effect.\r\nObjective. To evaluate whether uterine shrinkage induced by preoperative GnRH agonists in women with uteruses > 280g may\r\nfacilitate vaginal hysterectomy (VH).\r\nMaterial and methods. 23 women scheduled to have an abdominal hysterectomy based on the uterine size over 280 g were allocated to receive the GnRH agonist triptorelin 3.75 mg monthly for three months. Uterine weight (estimated by ultrasound), serum levels of estradiol and Hb were assessed before treatment and monthly afterwards three times.\r\nResults. Estradiol levels decreased from 235.9?15 to 38?3.7pg/mL at three months (p<0.0001), after an initial flare up. Hb increased from 11.85?1.8 to 12.7?0.74 g/dL.\r\nThe uterine weight decreased from 443.5?39 to 294.8?31 g (by 33.5%), all patients benefitting from a VH.\r\nConclusion. In women with a large uterus impending an abdominal hysterectomy, a 3-month preoperative course of GnRH agonists facilitates VH by decreasing uterine size by 30%.

Keywords: GnRH agonists, fibroid, vaginal hysterectomy

Correspondence: Alina Ursuleanu, Carol Davila University Medicine Pharmacy - Obstetrics Cantacuzino, 5-7 Ion Movila Str. Bucharest 020475, Romania Email:alina.ursuleanu@yahoo.com