A randomised controlled study of goserelin as adjunctive therapy prior to surgery in the management of uterine fibroids
AbstractContext: Luteinising hormone analogues are being increasingly advocated in the management of common oestrogendependent gynaecological conditions, notably uterine fibroids, endometriosis and menorrhagia.
Objective: The aim was to assess the effects of depot injections of goserelin (Zoladex®), a GnRH-agonist analogue, on the management of uterine fibroids.
Patients and Methods: Forty female pre-menopausal patients aged between 26 and 50 years, with uterine sizes 12 to 26 weeks were enrolled in a randomised controlled study. One group was prospectively randomized to surgery (deferred for 0 to 4 months) and another to goserelin treatment for 3 months, followed by surgery. Patients were included if they had a diagnosis of benign uterine fibroids and an abdomino-pelvic mass greater than 12 weeks gestational size.
Results: Uterine and fibroids volumes were reduced by a median value of 31.7% and 58.1% respectively for Zoladex patients compared with an increase of 3.3% and 0.6% in uterine and fibroid volumes in the surgery-only patients. The difference between the treatment groups for the absolute changes was statistically significant (P<0.0001). Patients in the goserelin group had a somewhat higher haemoglobin level by the time of surgery compared to the time of entry (P=0.06), had an easier operation and a shorter stay in hospital. Adverse events were more numerous in the goserelin treated patients.
Conclusion: Goserelin treatment, prior to surgery, demonstrated benefit in terms of uterine and fibroids volumes, symptoms reduction and improvement of haematological profile in Nigerian patients with uterine leiomyoma.
Keywords: uterine fibroids, goserelin, adjunctive therapy, surgery
Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 120-124
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