goserelin and Menorrhagia

Topics: Danazol; Endometrium; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysteroscopy; Menorrhagia; Progestins

Menorrhagia is one of the most common reasons for pre-menopausal women to be referred to a gynaecologist. Although medical therapy is generally the first approach, many women will eventually require or request a hysterectomy. Hysterectomy is associated with a significant in-patient hospital stay and a period of convalescence that makes it an unattractive and unnecessarily invasive option for many women. Hysteroscopic endometrial ablation or resection, and more recently "second generation" devices such as balloon or microwave ablation offer a day-case surgical alternative to hysterectomy for these women. They are also cheaper procedures than hysterectomy. Complete endometrial removal or destruction is one of the most important determinants of treatment success. Therefore surgery will be most effective if undertaken when endometrial thickness is less than four mm, in the immediate post-menstrual phase, however there are often difficulties in reliably arranging surgery for this time. The other option is the use of hormonal agents which induce endometrial thinning or atrophy prior to surgery. The most commonly evaluated agents have been goserelin (a GnRH analogue) and danazol. Progestogens and other GnRH analogues have also been studied although less data are available. It has been suggested that the use of these agents, particularly GnRH analogues, will reduce operating time, improve the intra-uterine operating environment, and reduce distension medium absorption (this is the fluid used to distend the uterine cavity during surgery). They may also result in a greater improvement in long term outcomes such as menstrual loss and dysmenorrhoea.. To investigate the effectiveness of gonadotrophin-releasing hormone (GnRH) analogues, danazol, and progestogens, when used for endometrial thinning prior to endometrial destruction for menorrhagia, in improving the intra-uterine operating environment and treatment outcome after surgery.. The Menstrual Disorders and Subfertility Group search strategy (see Review Group details) was used to identify randomised trials that had compared the use of these drugs with either each other, or placebo, or no pre-operative treatment. An updated search was performed in 2001-2002 to identify new trials.. Trials were included if they compared the effects of these agents with each other, or with placebo or no treatment on relevant intra-operative and post-operative treatment outcomes. Only randomised studies were included in this review.. Twelve studies met the inclusion criteria for this review. Five studies compared goserelin (a GnRH analogue) with no treatment or placebo and one study compared decapeptyl (a GnRH analogue) with no treatment. Three studies compared goserelin with danazol. Two studies compared progestogens, danazol and triptorelin or nasal spray nafarelin (both GnRH analogues) with no treatment. Only one study comparing triptorelin with no treatment assessed outcomes after balloon ablation and no studies assessing endometrial thinning agents prior to other second generation ablation techniques were identified. One study assessed the effects of progestogens compared to no treatment. Data were extracted independently by two reviewers. A third reviewer checked data extraction for accuracy and wrote to authors where relevant data was missing or unclear. Intra-operative parameters included endometrial thickness, duration of surgery, ease of surgery, distension medium absorption and complication rate. Post-operative outcomes included the proportion of women with amenorrhoea, post-operative menstrual loss and dysmenorrhoea, and the need for further surgery. Data on side-effects were also recorded.. When compared with no treatment, GnRH analogues are associated with a shorter duration of surgery, greater ease of surgery and a higher rate of post-operative amenorrhoea at 12 months with hysteroscopic resection or ablation. Post-operative dysmenorrhoea also appears to be reduced. The use of GnRH analogues has no effect on intra-operative complication rates and patient satisfaction with this surgery is high irrespective of the use of any pre-operative endometrial thinning agent. GnRH analogues produce more consistent endometrial atrophy than danazol. For other intra-operative and post-operative outcomes, any differences are minimal and there were no benefits of GnRHa pre-treatment in the one small study where women had balloon (second generation ablation). Both GnRH analogues and danazol produce side-effects in a significant proportion of women, though few studies have reported these in detail. Few randomised data are available to assess the effectiveness of progestogens as endometrial thinning agents. The effect of any thinning agent on longer-term results is less certain but where reported the effect of endometrial thinning agents on benefits such as post-operative amenorrhoea appears to reduce with time.. Endometrial thinning prior to hysteroscopic surgery in the early proliferative phase of the menstrual cycle for menorrhagia improves both the operating conditions for the surgeon and short term post-operative outcome. Gonadotrophin-releasing hormone analogues produce slightly more consistent endometrial thinning than danazol, though both agents produce satisfactory results. The effect of these agents on longer term post-operative outcomes such as amenorrhoea and the need for further surgical intervention reduces with time.

Topics: Danazol; Endometrium; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysteroscopy; Menorrhagia; Progestins

Menorrhagia is one of the most common reasons for pre-menopausal women to be referred to a gynaecologist. Although medical therapy is generally the first approach, many will eventually require or request a hysterectomy. Hysterectomy is associated with a significant in-patient hospital stay and a period of convalescence that makes it an unattractive and unnecessarily invasive option for many women. Hysteroscopic endometrial ablation or resection offers a day-case surgical alternative to hysterectomy for these women. It is also a cheaper procedure than hysterectomy. Complete endometrial removal or destruction is one of the most important determinants of treatment success. Therefore surgery will be most effective if undertaken when endometrial thickness is less than 4mm, in the immediate post-menstrual phase, however there are often difficulties in reliably arranging surgery for this time. The other option is the use of hormonal agents which induce endometrial thinning or atrophy prior to surgery. The most commonly evaluated agents have been goserelin (a GnRH analogue) and danazol. Progestogens and other GnRH analogues have also been studied although less data are available. It has been suggested that the use of these agents, particularly GnRH analogues, will reduce operating time, improve the intra-uterine operating environment, and reduce distension medium absorption (this is the fluid used to distend the uterine cavity during surgery).. To investigate the effectiveness of gonadotrophin-releasing hormone (GnRH) analogues, danazol, and progestogens, when used for endometrial thinning prior to hysteroscopic surgery for menorrhagia, in improving the intra-uterine operating environment and treatment outcome after surgery.. The Menstrual Disorders and Subfertility Group search strategy (see Review Group details) was used to identify randomised trials that had compared the use of these drugs with either each other, or placebo, or no pre-operative treatment.. Trials were included if they compared the effects of these agents with each other, or with placebo or no treatment on relevant intra-operative and post-operative treatment outcomes. Only randomised studies were included in this review.. Eight studies met the inclusion criteria for this review. Four studies compared goserelin (a GnRH analogue) with no treatment or placebo. Three studies compared goserelin with danazol. One study compared progestogens, danazol and triptorelin (a GnRH analogue) with no treatment. Data was extracted independently by two reviewers. A third reviewer checked data extraction for accuracy and wrote to authors where relevant data was missing or unclear. Intra-operative parameters included endometrial thickness, duration of surgery, ease of surgery, distension medium absorption and complication rate. Post-operative outcomes compared were the proportion of women with amenorrhoea, post-operative menstrual loss and dysmenorrhoea, and the need for further surgery. Data on side-effects were also recorded.. When compared with no treatment GnRH analogues are associated with a shorter duration of surgery, greater ease of surgery and a higher rate of post-operative amenorrhoea. Post-operative dysmenorrhoea also appears to be reduced. The use of GnRH analogues has no effect on intra-operative complication rates and patient satisfaction with this surgery is high irrespective of the use of any pre-operative endometrial thinning agent. GnRH analogues produce more consistent endometrial atrophy than danazol. For other intra-operative and post-operative outcomes any differences are minimal. Both GnRH analogues and danazol produce side-effects in a significant proportion of women, though few studies have reported these in detail. Little randomised data is available to assess the effectiveness of progestogens as endometrial thinning agents and the effect of any thinning agent

Topics: Danazol; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysteroscopy; Menorrhagia; Progestins

Topics: Anemia; Female; Goserelin; Humans; Leiomyoma; Menorrhagia; Uterine Neoplasms

Vaginal hysterectomy is considered the method of choice for removal of the uterus but most gynecologists still prefer the abdominal route for removal of benign uteri >14 weeks in size. Conversion of an abdominal to a potential vaginal hysterectomy by uterine size reduction would be advantageous. Gonadotrophin-releasing hormone (GnRH) agonists can reduce uterine bulk by up to 50%.. To evaluate the efficacy of the preoperative administration of a GnRH agonist for women with enlarged non-prolapsing uteri in order to facilitate vaginal hysterectomy, in comparison with patients with enlarged uteri who underwent direct total abdominal hysterectomy (TAH) for the same indication (menorrhagia).. Randomized controlled study. Women scheduled for hysterectomy for menorrhagia with a non-prolapsing uterus of ≥14 weeks size (by clinical and sonographic assessments) were offered a trial of vaginal hysterectomy after pre-treatment with a GnRH agonist (goserelin) for 3 months (study group=Group 1=40). A group of women with uteri of comparable size who underwent abdominal hysterectomy for similar indications served as controls (Group 2=40). Pre- and post-operative data such as hemoglobin, myoma size, uterine weight, duration of procedure and complications, pain score and length of hospital stay were collected prospectively.. The weight of the uterine specimen was significantly lower in Group 1 (511.7±217g) compared to Group 2 (736.8±212g); P<0.001. The mean objective decrease in clinical uterine bulk preoperatively in Group 1 was 20.1%. The duration of surgery was nearly 1.5 times as long in vaginal (119.6±41.7min) compared to abdominal hysterectomy (81.1±34.1min), P<0.001, but analgesia use and the length of inpatient stay were significantly lower in Group 1 (2.6±1.3 days) compared to Group 2 (4.12±1.7 days), P<0.001. There was no significant difference between the two groups as regards the rate of occurrence of surgical complications.. In women with ≥14 week size uteri, treatment with a GnRH agonist reduces uterine size sufficiently to allow safe vaginal hysterectomy. Although duration of surgery was longer, women who underwent vaginal hysterectomy required less analgesia and had a shorter inpatient stay.

Topics: Adult; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysterectomy, Vaginal; Menorrhagia; Middle Aged; Organ Size; Preoperative Care; Uterus

To evaluate the clinical outcomes following the use of goserelin and suction curettage prior to ThermaChoice II balloon endometrial ablation to treat menorrhagia.. Qualified patients (n = 105) were randomized to receive either goserelin 3.6 mg one month before or suction curettage immediately before undergoing thermal balloon endometrial ablation. All patients had negative Papanicolaou smears, normal endometrial histology, and normal findings on transvaginal sonography. Uterine bleeding was documented by menstrual diary scores at baseline (Higham score > 150), and at three, six, and 12 months after the procedure. Five patients withdrew prior to surgery and 50 patients were anaesthetized in each group. Two patients in the suction curettage group had their management converted to hysteroscopic ablation, one because of a large uterine cavity (> 12 mL) and one because of a submucous myoma. The ThermaChoice II system circulated the liquid within the silicone balloon for eight minutes at approximately 180 mmHg pressure and 87°C.. Participants' mean age, weight, and duration of menorrhagia were not significantly different between the groups. No safety issues related to the device were noted. At one year after ablation, the median reduction in Higham score was from 286 to 10 (96.5%) in the goserelin group (n = 47), and from 272 to 14 (94.9%) in the curettage group (n = 45). The combined amenorrhea/hypomenorrhea rates (higham score 0 to 35), eumenorrhea rate (higham score 36 to 75) and menorrhagia rate (higham score > 75) were 85%, 9%, and 6% (goserelin), and 76%, 16%, 9% (curettage), respectively. Patients' reported self-assessment of dysmenorrhea was none (51%), mild (30%), moderate (10%), and severe (9%) in both groups. Patient satisfaction was 89% in the goserelin group and 95% in the curettage group. In the goserelin group, one patient had a hysterectomy for bleeding and two had repeat resectoscopic endometrial ablations, one for pain (hematometra) and one for pain and bleeding. In the curettage group, one patient had repeat resectoscopic ablation, one patient withdrew, and one requested hormone therapy. The overall success rates were 88% in the goserelin group and 89% in the curettage group.. At one year after ThermaChoice II treatment, 88.5% of women had normal menstrual bleeding or less. There was a non-significant trend (a lower Higham score) towards superiority of goserelin therapy before ablation compared with curettage.

Topics: Adult; Catheterization; Endometrial Ablation Techniques; Female; Goserelin; Hot Temperature; Humans; Hysteroscopy; Menorrhagia; Middle Aged; Treatment Outcome; Vacuum Curettage

To obtain information on the efficacy of repeated short cycles of GNRH agonist treatment in order to avoid hysterectomy in near-menopausal women with symptomatic fibroids.. 72 pre-menopausal women (mean age 50 years) with one or more uterine fibroids >10 cm in diameter, symptomatic menorrhagia lasting three months or more and haemoglobin=9 g/dl entered the study. The patients were randomized with ratio of approximately 1:4 to: (a) immediate surgery; or (b) treatment with goserelin acetate. Patients randomized to goserelin acetate received a first cycle of 3.6 mg depot once every 28 days for four months. They were followed-up for three years. If menorrhagia was observed during the follow-up the woman was given goserelin acetate 3.6 mg depot for another three months. In case of further menorrhagia, a third cycle of goserelin acetate 3.6 mg depot for three months was given. After the third cycle of therapy if there was still menorrhagia, the patient underwent hysterectomy plus bilateral oophorectomy.. A total of 13 women were assigned to the immediate surgery group and 59 to goserelin. Three years after trial entry a total of 23 women allocated to goserelin acetate treatment had undergone hysterectomy.. This study suggests that GNRH agonists are efficacious for avoiding hysterectomy in women near menopause with uterine fibroids.

Topics: Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysterectomy; Leiomyoma; Menorrhagia; Middle Aged; Ovariectomy; Premenopause

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

To assess the value of endometrial preparation, with preoperative and pre- and postoperative GnRH agonist therapy in transcervical endometrial resection.. Sixty women with menorrhagia were randomly divided between three groups: A: no preoperative preparation, B: goserelin 3.6 mg given as a subcutaneous implant 4-6 weeks preoperatively, and C: the same regimen as B, and repeated on the day of endometrial resection. At follow-up visits 1, 3, 6 and 12 months after operations the patients were interviewed for duration, amount and pains of menstrual periods.. The duration of surgery for the pretreated group (32.8 +/- 5.1 min) and the group treated postoperatively (30.9 +/- 8.9 min) were significantly shorter than that in the control group (46.4 +/- 11.5 min) (p < 0.01). The weight of endomyometrial strips was about 3 times lower for group B and C as compared to group A (p < 0.01). Three months following the procedure twenty five percent of patients in group A were amenorrheic or showed scanty bleeding as compared to 58% and 85% in group B and C (p < 0.05 and p < 0.01), respectively. At 12 months follow-up these rates were 35%, 58% and 67% respectively (A versus B: NS, A versus C: p < 0.05) and 24%, 65% and 75% after excluding larger submucosal fibroids (A versus B: p < 0.025, A versus C: p < 0.005). No statistical difference was demonstrated between group B and C. Sixty-nine percent of pretreated patients (group B + C) versus 35% of women in group A reported improved or relieved menstrual cramps (p < 0.05).. GnRH pretreatment facilitates endometrial resection and increases the rate of amenorrhea and scanty bleeding postoperatively. Whether supplementary postoperative therapy with GnRH agonist enhances the success rate further is uncertain.

Topics: Adult; Endometrium; Female; Goserelin; Humans; Menorrhagia; Middle Aged; Postoperative Care; Preoperative Care

To compare the safety and efficacy of a GnRH agonist, depot goserelin, and danazol as preoperative treatments before rollerball endometrial ablation.. We performed an open, randomized study of women with clinically convincing histories of menorrhagia. Two treatment groups of equal size (goserelin acetate, 3.6 mg subcutaneous implant given monthly, n = 30; and danazol, 200 mg two times per day, n = 30) were treated for 2 months before undergoing endometrial ablation, which entailed using the rollerball with 80-100 watts of coagulating current.. Measured menstrual blood loss decreased dramatically after ablation, with 74% of goserelin users and 62% of danazol users achieving complete amenorrhea by the end of the 6-month follow-up period. Among women who did not achieve complete amenorrhea, those in the danazol group were more likely to experience occasional episodes of moderate or heavy bleeding. Mean measured blood loss decreased from 94.8 to 1.1 mL at 3 months and 1.0 mL at 6 months after goserelin, and 97.9 to 15.0 mL and 7.4 mL after danazol. Menstrual pain also improved markedly. The median duration of surgery was 20 minutes (range 5-55) in both groups, median irrigation fluid deficit was 100 mL (range 0-800), and median operative blood loss was 20 mL (range 1-50). Endometrium was less than 2 mm thick in all goserelin and most danazol users. Side effects of goserelin and danazol therapy were all within the expected pattern for these drugs.. Depot goserelin and danazol both provide adequate endometrial preparation before rollerball endometrial ablation for treatment of menorrhagia due to ovulatory dysfunctional uterine bleeding.

Topics: Combined Modality Therapy; Danazol; Delayed-Action Preparations; Endometrium; Estrogen Antagonists; Female; Goserelin; Humans; Laser Coagulation; Menorrhagia; Preoperative Care

To ascertain whether treatment with a gonadotrophin releasing hormone agonist before endometrial resection reduces absorption of distension fluid and operating time and facilitates the procedure.. A multicentre, prospective, randomised controlled study.. Seventy-one premenopausal women with established menorrhagia.. Eight weeks of goserelin depot treatment before endometrial resection of immediate surgery in the early proliferative phase of the cycle.. Irrigation fluid deficit, operating time and degree or difficulty of the procedure.. After randomisation eight women withdrew from the study, leaving 33 women in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) min in the goserelin group versus 16.9 (9.5) min in the controls; mean difference + 1.8 min, 95% CI, -2.9 to + 6.4. Mean (SD) distension medium deficit was, respectively, 422 (287) ml versus 564 (291 ml); mean difference + 142 ml, 95% CI -4 to + 288. The goserelin effect was restricted to the 29 women with adenomyosis as the mean (SD) fluid deficit was considerably less in the 19 treated women than in the 10 controls (299 (206) ml versus 597 (135) ml; mean difference + 298 ml, 95% CI + 149 to + 447). The surgeons classified the intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1.. Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in women with adenomyosis and may facilitate intrauterine operating conditions.

Topics: Absorption; Combined Modality Therapy; Delayed-Action Preparations; Female; Goserelin; Humans; Menorrhagia; Middle Aged; Premenopause; Preoperative Care; Prospective Studies; Therapeutic Irrigation; Treatment Outcome

To compare the effects of goserelin acetate treatment with or without iron with iron alone.. Multinational, multicenter, prospective, randomized, double-blind study.. Premenopausal women with menorrhagia or metrorrhagia and anemia associated with uterine leiomyomata awaiting hysterectomy.. Patients were randomized to one of three 12-week treatment groups namely goserelin acetate 3.6 mg once monthly plus placebo iron; 3.6 mg goserelin acetate once monthly plus 600 mg/d iron; or sham injection once monthly plus 600 mg/d iron.. Preoperative hemoglobin concentration; preoperative uterine and fibroid volumes and operative blood loss.. Considering the entry and preoperative hemoglobin concentrations, there was a difference in least square means of just over 1 g/dL between the goserelin acetate plus iron and iron only groups and 2.6 g/dL between the goserelin acetate plus iron and goserelin acetate only group. These differences were both statistically significant. Uterine and fibroid volumes were decreased in the goserelin acetate-treated patients by between 37% and 40% and 44% and 47%, respectively, compared with 7% decreases for both in the iron only group. The differences in absolute changes were statistically significant for both the goserelin acetate-treated groups versus the iron-treated group. The least square geometric mean operative blood loss was greatest in the iron only group.. In the patient with uterine leiomyomata and anemia, goserelin acetate in combination with iron therapy has shown significant advantages over the iron alone in restoring hematologic normality, decreasing uterine and fibroid volumes, and reducing operative blood loss.

Topics: Adult; Anemia, Iron-Deficiency; Antineoplastic Agents, Hormonal; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Goserelin; Hemoglobins; Humans; Iron; Leiomyoma; Menorrhagia; Middle Aged; Outcome Assessment, Health Care; Prospective Studies; Uterine Neoplasms

The gonadotrophin-releasing hormone (GnRH) agonists are an efficacious medical approach for the management of both dysfunctional uterine bleeding (DUB) and uterine fibroids. However, due to the long-term effects of GnRH agonists on bone mass, their use is restricted to short courses. Add-back hormone replacement therapy (HRT) is one strategy that could minimise the hypo-oestrogenic effects of GnRH agonists, without nullifying their therapeutic effects. In one study of add-back therapy with cyclical oestradiol/norgestrol in combination with Zoladex (goserelin acetate) in women with subjective DUB, the duration of menstruation, the number of days of heavy bleeding and objective blood loss were all significantly (P < 0.001) reduced. There was also significant (P < 0.001) symptomatic improvement. Furthermore, in 51 patients with symptomatic uterine fibroids, combined oestrogen/progestogen given for 21 months after initial GnRH agonist treatment for 3 months did not promote fibroid regrowth. In contrast, in women randomised to progestogen only, there was a gradual increase in uterine volume. The combination of GnRH agonists and add-back HRT appears beneficial for women with either DUB or fibroids.

Topics: Adult; Climacteric; Drug Combinations; Drug Therapy, Combination; Estradiol; Estrogen Replacement Therapy; Female; Goserelin; Headache; Humans; Leiomyomatosis; Medroxyprogesterone Acetate; Menorrhagia; Middle Aged; Norgestrel; Progestins; Treatment Outcome; Uterine Neoplasms

STUDY-PLAN: an open study aimed at evaluating the results of a short term therapy (3 months) with Goserelin depot as a medical treatment of premenopausal dysfunctional uterine bleeding.. 60 premenopausal women (aged 36-50) with dysfunctional uterine bleeding, presenting simple endometrial hyperplasia.. after the treatment, spontaneous menstrual bleeding recurred in 57/60 patients, while 3/60 (5%) patients remained amenorrheal during the whole period of follow-up, showing a postmenopausal hormonal pattern. In the first post-therapy menstrual cycle all the 57 patients had a bleeding score < 100; patients relapsing during the second, third and fourth cycle were respectively 2/54 (3.7%), 5/48 (10.7%) and 17/38 (44.7%). The fourth post-therapy cycle was delayed 6-9 months after the last injection of Goserelin. Both the mean blood loss and the mean duration of bleeding were significantly reduced in all post-therapy cycles. Eleven patients were anaemic before therapy (Hb < 12 g%); Goserelin treatment resulted in a normalization of the hematological parameters. At the end of treatment a small area of hyperplasia persisted in only 4/60 patients (6.7%). Localised or diffused hyperplasia were found respectively in 5/54 (9.3%) and in 1/54 patients (1.9%) at three months, and in 5/48 (10.4%) and 4/48 (8.3%) at a six-month follow-up. Side effects were infrequent.. the long symptom-free period and the low incidence of side effects indicates Goserelin depot as a valuable medical treatment for dysfunctional uterine bleeding.

Topics: Adult; Delayed-Action Preparations; Dose-Response Relationship, Drug; Endometrial Hyperplasia; Female; Goserelin; Humans; Menorrhagia; Metrorrhagia; Middle Aged; Premenopause

Our objective was to evaluate the effect of endometrial thinning by GnRH agonists on the results of hysteroscopic endometrial electrosurgical resection. In a prospective study, 32 women were treated with the GnRH agonist goserelin (Zoladex) before hysteroscopic endometrial resection. Endometrial thickness was measured before and after GnRH-a therapy by ultrasound. Short-term results in diminished vaginal blood loss and patient satisfaction were registered. The mean endometrial thickness (ET) before GnRH-a is 3.7 mm and after GnRH-a is 1.9 mm. In 24 cases, ET was reduced by a mean of 2.6 mm, in 1 case, no change was seen, and in 7 cases, ET increased by a mean 1.1 mm. The mean thickness rate (TR = ET before and after GnRH) is 2.7 (range 0.3-11). Fluid resorption during hysteroscopic surgery does not relate to ET or TR. Although the ET after GnRH-a therapy is not related to success or failure of the endometrial resection, there is some evidence that the TR is, probably expressing a more active state of the endometrium. Endometrial thinning by GnRH-a may have an effect on the results of hysteroscopic endometrial resection. In light of the present study and the literature, there seems to be no justification for abandoning preparation of the endometrium before hysteroscopic surgery.

Topics: Adult; Electrosurgery; Endometrium; Female; Goserelin; Humans; Hysteroscopy; Menorrhagia; Middle Aged; Prospective Studies; Ultrasonography

To evaluate the effects of treatment with the gonadotropin releasing hormone (GnRH) agonist goserelin before endometrial resection on absorption of distension medium fluid and technical feasibility of the surgical procedure.. Fifty-five patients reporting menorrhagia underwent endometrial resection after 2 months of goserelin depot therapy (33 cases) or during the proliferative phase of the cycle (22 controls).. In the cases, the mean distension medium deficit +/- S.D. was 511 +/- 196 ml versus 647 +/- 245 ml in controls (P = 0.03), and the operating times were, respectively, 14 +/- 4 versus 18 +/- 5 min (P = 0.002). The intrauterine operating conditions were considered excellent or good in 64% of the cases versus 27% of the controls (chi 2 = 5.60, P = 0.02).. GnRH agonists induce endometrial thinning, so that when administered before intrauterine interventions, mucus cellular debris and bleeding should be reduced during surgery and hysteroscopic visibility increased; the operating time may thus be shorter and fluid absorption decreased. However, more data are needed before considering GnRH agonists a proven effective means of facilitating endometrial resection.

Topics: Adult; Endometrium; Female; Goserelin; Humans; Hysteroscopy; Menorrhagia; Middle Aged; Preoperative Care

Topics: Adult; Danazol; Electrocoagulation; Endometrium; Female; Goserelin; Humans; Menorrhagia; Middle Aged; Preoperative Care; Treatment Outcome

Uterine myomas and endometriosis are benign pathologies frequently encountered in women. Myomas are often associated with infertility and/or menorrhagia particularly if they are sub-mucosal. Endometriosis is diagnosed in more than 35% of infertile patients. These two common pathologies are oestrogen-dependent and the administration of a GnRH agonist has been proposed as a non-surgical approach to the treatment of myomas and endometriosis. GnRH agonists cannot, however, be considered as definitive medical therapy because most myomas and endometriotic cysts return to their initial size within 4 months following the cessation of treatment. Moreover, because of the menopausal-like state that they induce, GnRH agonists provoke bone demineralization and for this reason, their long-term use is not recommended. These agents should, therefore, be considered as an adjuvant preoperative therapy. The aim is, above all, to achieve a preoperative reduction of tumour size, thus facilitating the endoscopic surgery: either hysteroscopic resection in the case of sub-mucosal myomas, or vaporization of ovarian cysts in the case of cystic endometriotic lesions.

Topics: Adult; Biopsy; Combined Modality Therapy; Endometriosis; Female; Goserelin; Humans; Hysteroscopy; Infertility, Female; Laparoscopy; Leiomyoma; Menorrhagia; Ovarian Cysts; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Neoplasms

Hot flushes are the commonest symptom induced by gonadotropin-releasing hormone agonists (GnRHa). We performed an open observational trial to evaluate the efficacy of veralipride, an antidopaminergic drug, in reducing hot flushes in 25 premenopausal women treated with a GnRHa for endometriosis (8 subjects) or menorrhagia (17 subjects). The patients received goserelin depot for 6 months and veralipride was added for the third month. Hot flushes, severe in all women at 2 months, improved in both frequency and intensity in 92% of the subjects during veralipride administration. The benefit obtained persisted until the end of the GnRHa treatment.

Topics: Adult; Drug Therapy, Combination; Endometriosis; Estradiol; Female; Flushing; Follicle Stimulating Hormone; Goserelin; Humans; Luteinizing Hormone; Menorrhagia; Middle Aged; Prolactin; Sulpiride

Menorrhagia is the most frequent symptom in women with leiomyomata uteri. We induced transient hypoestrogenism with a gonadotropin-releasing hormone agonist, goserelin (Zoladex, I.C.I.), in a depot formulation, to resolve severe anemia in 16 women with uterine myomas. Subcutaneous administration of goserelin 3.6 mg was repeated every 28 days for 6 months. Thirteen patients became amenorrheic in 5 weeks and 3 reported scanty bleeding. Estradiol fell to postmenopausal levels after one month's treatment with hormonal surges on only three occasions. Uterine volume decreased by 49% after 3 months' treatment but subsequent reduction was not achieved. Mean hemoglobin rose from 7.4 g/dl pretreatment to 13.2 g/dl at 3 months (+78.3%) and mean hematocrit from 26.1% to 39.8% (+52.4%) without any further improvement. Serum ferritin increased constantly during the 6 months. Goserelin depot therapy in severely anemic patients with leiomyomas and menorrhagia is practical, safe and may avoid the need for preoperative transfusion.

Topics: Adult; Anemia, Hypochromic; Buserelin; Delayed-Action Preparations; Female; Goserelin; Humans; Leiomyoma; Menorrhagia; Middle Aged; 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

Topics: Abdominal Pain; Danazol; Diagnosis, Differential; Dysmenorrhea; Endometriosis; Estrogen Antagonists; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Hysterectomy; Laparoscopy; Leuprolide; Menorrhagia; Nafarelin; Nursing Assessment; Physical Examination; Progesterone; Severity of Illness Index

We treated eleven cases of high risk surgical candidate women with prosthetic heart valves, complaining of menorrhagia, by thermal balloon ablation under local anesthesia after pharmacological endometrial thinning. Menorrhagia was documented by a validated pad scoring system. All patients were severely anemic at presentation. Nine of them had one valve replaced among these cases, two were restenosic at presentation, one had twice mitral valve replacement. Two of them had two valves replaced. All procedures were performed under local anesthesia supplemented by analgesics, no complications were observed either intraoperatively or during the follow-up of at least 24 months. After two years, thermal balloon ablation proved to be statistically significantly effective in terms of pad score reduction; two patients reported spotting and the rest was hypomenorrheic, none of the group experienced amenorrhea. This technique proved to be safe, feasible and effective under this clinical circumstances.

Topics: Adult; Anesthesia, Local; Catheterization; Endometrium; Female; Follow-Up Studies; Goserelin; Heart Valve Prosthesis Implantation; Heating; Humans; Menorrhagia; Middle Aged; Postoperative Complications; Premedication; Treatment Outcome

To assess medium-term efficacy of rollerball endometrial ablation in a district general hospital.. From March 1992 to June 1997, 91 women underwent rollerball endometrial ablation for uncontrolled menorrhagia unresponsive to medical treatment. Each was sent a detailed questionnaire after at least 18 months (range 18-55). There was an overall response rate of 88% (80/91). Case notes were reviewed to collect additional data related to pre-operative management and actual operative procedure. The main outcome measures included treatment satisfaction, relief of symptoms, improvement in health related quality of life, at least 18 months after surgery.. Thirty-five of the 80 women (44%) had achieved amenorrhea. Ten women required further treatment; of these seven had a hysterectomy (9%). None of the non-responders had a hysterectomy. Following rollerball endometrial ablation, many women reported improvement in cyclical pelvic pain (73%), pre-menstrual symptoms (65%), ability to do housework (85%), and an improved sexual life (96%). Seventy-nine (99%) women were able to return to normal work within 4 weeks following surgery. The majority of them remained satisfied with treatment (79%) and they would recommend it to a friend (91%).. Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the treatment of menorrhagia in selected cases. Longer-term follow up is still needed to establish the ultimate effectiveness of the procedure.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Antineoplastic Agents, Hormonal; Danazol; Endometrium; Estrogen Antagonists; Female; Follow-Up Studies; Goserelin; Humans; Menorrhagia; Middle Aged; Patient Satisfaction; Quality of Life; Surveys and Questionnaires

We report a case with menorrhagia due to uterine fibroids who was admitted following an episode of unstable angina. Her coronary angiogram showed a tight proximal left anterior descending artery lesion for which stenting was deemed necessary. She was successfully anticoagulated in spite of her menorrhagia under cover of a gonadotrophin hormone releasing agonist; goserilin.

Topics: Angina, Unstable; Antineoplastic Agents, Hormonal; Coronary Angiography; Electrocardiography; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Goserelin; Hemoglobins; Humans; Injections, Subcutaneous; Leiomyoma; Menorrhagia; Middle Aged; Stents; Uterine Neoplasms

To evaluate the prevalence of resumption of menstruation after an interval of amenorrhea in women treated by endometrial ablation and myometrial resection.. Retrospective analysis.. Tertiary care university-affiliated teaching hospital.. One hundred fifty-seven consecutive patients treated for menorrhagia refractory to medical therapy.. Loop resection or rollerball ablation of the endometrium.. At 6 to 12 months postoperatively, 50. 6% of patients were amenorrheic and 35.1% had hypomenorrhea. Over follow-up of 13 to 30 months, 45.1% of women became amenorheic and 40.5% had satisfactory hypomenorrhea. Resumption of menstruation after any interval of amenorrhea occurred in 27.2% of amenorheic patients. We observed an increasing trend to resumption of menstruation after rollerball ablation (29.4%) compared with loop resection (26.7%) and after preoperative endometrial suppression with buserelin (37.5%) and leuprolide (27.1%) compared with danazol (12.5%) and goserelin (10.5%). Resumption of menstruation occurred in 44.4% of women who did not have preoperative endometrial suppression.. Our results suggest that resumption of menstruation does occur after a variable interval of amenorrhea following endometrial ablation and myometrial resection. It could potentially be used as a marker of failure of endometrial destruction.

Topics: Amenorrhea; Buserelin; Danazol; Electrocoagulation; Endometrium; Female; Follow-Up Studies; Goserelin; Humans; Leuprolide; Menorrhagia; Myometrium; Postoperative Complications; Preoperative Care; Retrospective Studies; Time Factors; Treatment Failure

Topics: Danazol; Endometriosis; Endometrium; Female; Follow-Up Studies; Goserelin; Hemostasis, Endoscopic; Humans; Hysteroscopy; Laser Therapy; Leiomyoma; Menorrhagia; Preoperative Care; Treatment Outcome; Uterine Neoplasms

Glandular Hyperplasia is commonly associated with meno and/or metrorrhagia. We treated 84 patients suffering from meno and/or metrorrhagia associated with simple glandular hyperplasia with a gonadotropin releasing hormone agonist, goserelin, (Zoladex, ICI Pharmaceuticals, Macclesfield. Cheshire, England), available in a depot formulation. Subcutaneous administration of goserelin 3.6 mg was repeated every 28 days for 6 months. Within the first 4 weeks from the start of therapy 45% of the patients became amenorrhoeic, within 12 weeks 100%. Only 3 patients reported continued spotting. Hysteroscopic evaluation and biopsy have shown in the 84 evaluable patients, a positive result in 76 (90.4%), demonstrating the validity of the use of this analogue in this indication. In the future it would be of value to increase the period of treatment in selected cases as well as increasing the length of the follow-up period.

Topics: Adult; Delayed-Action Preparations; Endometrial Hyperplasia; Female; Follow-Up Studies; Goserelin; Humans; Hysteroscopy; Injections, Subcutaneous; Menorrhagia; Metrorrhagia; Middle Aged; Uterus

Nineteen patients with simple endometrial hyperplasia presenting metrorrhagia or menometrorrhagia were treated with 4 injections of Goserelin depot, one every 4 weeks. 12/19 patients were refractory after previous medical therapy. The treatment with Goserelin depot resulted in a complete remission of the symptoms, occurring within the first month of treatment and still present after a median follow-up of 12 months, and in the normalization of the histological profile. No patient experienced clinically relevant side effects.

Topics: Biopsy; Delayed-Action Preparations; Endometrial Hyperplasia; Endometrium; Female; Goserelin; Humans; Menorrhagia; Metrorrhagia

To investigate the effect of gonadotropin releasing hormone agonist (goserelin) treatment before hysterectomy for leiomyomata-associated menorrhagia.. Prospective, comparative, nonrandomized study.. A teaching hospital of Milano University.. Anemic women requiring hysterectomy for myoma-associated menorrhagia.. Six months' preoperative goserelin treatment (41 cases) or immediate surgery (92 controls).. Abdominal/vaginal hysterectomy rate, number of transfusions, operating time, blood loss, complications, febrile morbidity, and days in hospital.. In the goserelin group mean hemoglobin rose (8.5 versus 13.3 g/dl) and mean uterine volume decreased (528 versus 251 ml). At preoperative pelvic exploration abdominal hysterectomy was indicated in 22 (54%) cases and 74 (80%) controls and vaginal hysterectomy in 19 (46%) and 18 (20%) (relative risk 3.6, 95% confidence interval 1.6 to 7.7; p = 0.001). No case required a transfusion whereas 51% of controls needed a total of 127 packed red cell units.. In anemic women with menorrhagia and leiomyomas, gonadotropin releasing hormone agonist treatment before hysterectomy limited transfusion requirements and increased the vaginal procedure rate.

Topics: Adult; Anemia, Hypochromic; Female; Goserelin; Humans; Hysterectomy; Leiomyoma; Menorrhagia; Middle Aged; Premedication; Prospective Studies; Treatment Outcome; Uterine Neoplasms

Twenty-three women with chronic heavy anovulatory uterine bleeding and severe iron-deficiency anemia received six months' treatment with goserelin, a gonadotropin releasing hormone agonist, administered as a monthly subcutaneous depot. After two months of treatment, all patients were amenorrheic and subsequent spotting was reported on only nine occasions. Laboratory results showed the following values: mean hemoglobin before treatment, 7.9 g/dL-13.8 g/dL at six months (+75%); mean hematocrit, 26.3%-41.6% (+58); mean serum iron, 19.8 micrograms/dL-63.3 micrograms/dL (+134%) and mean serum ferritin, 6.2 ng/mL-35.3 ng/mL (+469%). The endometrial hyperplasia observed in 11 subjects showed regression at follow-up suction biopsy. Gonadotropin releasing hormone agonists administered in a depot formulation for a few months in highly selected patients with severe anemia associated with heavy anovulatory uterine bleeding are practical, safe and effective, may avoid blood transfusions and could be used as a first line of treatment.

Topics: Adult; Anemia, Hypochromic; Anovulation; Delayed-Action Preparations; Female; Goserelin; Humans; Menorrhagia; Middle Aged

Four patients with heavy menorrhagia, severe iron-deficiency anemia and contraindications to surgery were treated with a gonadotropin-releasing hormone agonist in a depot formulation. At 2 months of therapy they were all amenorrheic, and at 6 months the hematologic values had improved markedly. Gonadotropin-releasing hormone agonists may obviate emergency surgery in patients at high surgical risk or could constitute the first line of sequential therapeutic regimens, once general health conditions have improved.

Topics: Adult; Buserelin; Contraindications; Female; Goserelin; Humans; Hysterectomy; Menorrhagia; Middle Aged

To observe if a combination of a depot GnRH agonist and cyclical hormone replacement therapy decreases menstrual blood loss.. An open, observational study comparing the objective assessment of menstrual blood loss before, during and after 3 months treatment.. 20 women with a subjective complaint of heavy menstrual loss in whom no cause could be discovered.. Each woman received 3 months of depot goserelin (Zoladex) combined with cyclical hormone replacement therapy (Cyclo-Progynova, 1 mg). Menstrual loss and symptoms were assessed before, throughout and after the study.. Changes in objective and subjective assessments of menstrual blood loss and the acceptability of the treatment.. The median pretreatment menstrual loss was 68 ml (range 23-397). Only 8 (40%) of the patients had a loss exceeding 80 ml per period. The median blood loss was 30 ml, 16 ml, and 17 ml in the three treatment cycles (P less than 0.001 Wilcoxon rank sum for the third cycle). There was a significant decrease in the median length of menstruation (P less than 0.001) and the number of towels or tampons (P less than 0.01) used per period in the third treatment cycle. There was a significant decrease (P less than 0.005) in the number of women complaining of dysmenorrhoea, premenstrual symptoms, flooding and the passage of clots. Seventeen patients experienced hot flushes. Eighteen of the 20 patients were completely satisfied with the treatment and would have been happy to continue with it for longer than 12 months.. The combination of a depot gonadotrophin releasing hormone agonist and cyclical hormone replacement therapy is a successful and acceptable treatment of dysfunctional uterine bleeding.

Topics: Adult; Buserelin; Drug Therapy, Combination; Estradiol; Female; Goserelin; Humans; Injections, Subcutaneous; Menorrhagia; Middle Aged; Prospective Studies; Treatment Outcome