goserelin and Adenomyoma

To verify if more favorable long-term results of endometrial resection can be obtained with preoperative gonadotropin-releasing hormone (GnRH) agonist treatment.. Multicenter, randomized, controlled trial (Canadian Task Force classification I).. Tertiary care academic department.. Sixty-three premenopausal women with established menorrhagia.. Eight weeks of goserelin depot treatment before endometrial resection or immediate surgery in the early proliferative phase of the cycle.. 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.. 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.

Topics: Adenomyoma; Adult; Antineoplastic Agents, Hormonal; Delayed-Action Preparations; Electrocoagulation; Endometrium; Endoscopy; Female; Goserelin; Humans; Menorrhagia; Middle Aged; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Neoplasms

The aim of our study was to assess the long-term efficacy of conservative surgery combined with gonadotropin-releasing hormone agonist therapy for uterine adenomyoma.. We carried out an uncontrolled descriptive study of 285 women who had symptomatic uterine adenomyoma. A total of 186 women with pathologically proven adenomyoma underwent ultramini-laparoscopic adenomyomectomy and a 6-month course of goserelin acetate treatment, and were evaluated semi-annually during a follow-up period of at least 3 years.. Patient scores for dysmenorrhea using a self-reported six-point verbal numeric rating scale significantly declined compared with the baseline assessment, from 3.84 ± 0.65 to 0.33 ± 0.57, 0.52 ± 0.86, and 0.88 ± 1.29 at the end of the 1-, 2-, and 3-year follow-up visits, respectively (p < 0.001). Similar reductions were observed for analgesic usage scores. Menorrhagia scores significantly decreased compared with the baseline assessment, from 3.45 ± 1.46 to 0.42 ± 0.59, 0.65 ± 0.83, and 1.1 ± 1.34 at the end of the 1-, 2-, and 3-year follow-up visits, respectively (p < 0.001).. Combination therapy for adenomyoma provides an effective treatment option for long-term symptom control and uterine preservation in severely symptomatic women for whom previous long-term drug therapy has failed or proven to be intolerable.

Topics: Adenomyoma; Adolescent; Adult; Antineoplastic Agents, Hormonal; Chemotherapy, Adjuvant; Drug Administration Schedule; Dysmenorrhea; Female; Follow-Up Studies; Goserelin; Humans; Kaplan-Meier Estimate; Laparoscopy; Menorrhagia; Middle Aged; Severity of Illness Index; Treatment Outcome; Uterine Neoplasms; Uterus; Young Adult