goserelin and Polyps

To evaluate the benefits of systematic preoperative treatment with LH-RH agonists prior to endometrial resection (ER).. The study population was made up of 98 premenopausal women who underwent resectoscopic treatment for abnormal uterine bleeding (AUB) between January 1996 and December 1997. Only patients with endometrial polyps or dysfunctional bleeding were included. The population was divided into two groups: patients who had (group B) and those who had not (group A) received LH-RH before the surgical intervention.. ER was carried out as a single procedure in 66 (67.5%) of the patients. ER plus polypectomy was necessary in 32 (32.5%) patients. There were no differences between the two groups as far as the operating time and total volume of distension medium were concerned. No intraoperative complications were seen in either group. A higher negative balance of distension medium was achieved in group A (320 +/- 23 mL versus 187 +/- 16 mL; P < 0.001), and this difference was not modified when cases with polyps were excluded. The failure rate was similar in both groups both at 12 months [group A 6 (14.8%) versus group B 7 (14.9%) patients] and at 60 months [group A, 11 (21.6%) versus group B 10 (21.2%) patients]. Likewise, the amenorrhea and hypomenorrhea rates at 12 months and at 60 months were also shown to be the same in both groups. When two doses of LH-RH are used and the failure rate is taken into account the cost of an acceptable outcome increases from 843.37 Euro to 1373.49 Euro per patient, while the total cost of a hysterectomy is 1355.42 Euro.. Endometrial suppression with LH-RH agonists did not guarantee better results of ER, but they are strongly recommended during the learning curve to achieve a safer procedure.

Topics: Adult; Endometrial Neoplasms; Endometrium; Female; Gonadotropin-Releasing Hormone; Goserelin; Gynecologic Surgical Procedures; Hormones; Humans; Middle Aged; Polyps; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Hemorrhage

A very rare--casuistic--case of endometriosis is presented, which appeared ten years after surgical menopause (hysterectomy and ovariectomy) without concomitant use of hormone replacement therapy or phytoestrogens. The possibilities of endogenous production and exogenous supply of estrogens in the female organism are discussed as well as the possible causes of proliferation of endometrial lesions during postmenopausal period. When menopause is induced by surgery (a stress for the organism) without exogenous supply of estrogens (HRT, phytoestrogens, xenoestrogens) the production of suprarenal hormones, including androgens, increases. The peripheral conversion of androgens into estrogens in fat tissue is increased and implanted during hysterectomy endometrial lesions in vagina walls are stimulated.

Topics: Aged; Diagnosis, Differential; Endometriosis; Estradiol; Female; Goserelin; Hemorrhage; Humans; Hysterectomy; Ovariectomy; Polyps; Postmenopause; Testosterone; Vaginal Diseases

A 30-year old female who initially had typical endometriosis treated according to a standard regimen later developed numerous highly vascular endometrial polyps on the vagina, cervix, ureter, serosal surfaces of the uterus, pouch of Douglas (POD) and other areas of pelvic peritoneum as well as the endometrium 8 months after withdrawal of treatment with Zoladex gonadotrophin releasing hormone (GnRH) agonist used for treatment of this disease. We postulate that these polyps developed as a rebound phenomenon upon withdrawal of Zoladex. We believe this is the first report of this complication following use of GnRH analogue.

Topics: Adult; Antineoplastic Agents, Hormonal; Endometrial Neoplasms; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Polyps; Substance Withdrawal Syndrome