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The Impact of Preoperative Gonadotropin-Releasing Hormone Agonist Treatment on Women With Uterine Fibroids: A Meta-analysis

Zhang, Ying MD*; Sun, Li MD; Guo, Yinshu MM; Cheng, Jiumei MM; Wang, Yongjun MD*; Fan, Shuying MD§; Duan, Hua MD

Obstetrical & Gynecological Survey: February 2014 - Volume 69 - Issue 2 - p 100–108
doi: 10.1097/OGX.0000000000000036
CME Articles

Aim The objectives of this study were to evaluate the efficacy of gonadotropin-releasing hormone agonist (GnRHa) treatment before surgery for women with uterine fibroids and to explore potential factors predicting the pooled effect sizes.

Methods A meta-analysis was performed from published randomized controlled trials using the random-effects model. The efficacy of preoperative treatment with GnRHa was investigated according to volume measurements of fibroid tumors, postoperative complications, myoma recurrence, and changes in fertility. Metaregression and subgroup analysis were used to identify potential predictors of the effect sizes.

Results A total of 26 studies were selected for the meta-analysis. Preoperative GnRHa therapy for women with uterine fibroids was associated with a smaller preoperative volume of fibroid tumors, increased hemoglobin and hematocrit levels, reductions in preoperative pelvic symptoms and the vertical incision rate, and a higher proportion of patients undergoing a vaginal procedure. No differences were observed in postoperative complications, myoma recurrence, and changes in fertility in the GnRHa-treated patients compared with patients treated with placebo or alternative clinical agents. The metaregression suggested that age, the duration of GnRHa treatment, the type of control group, and the type of surgery were important predictors of the efficacy of preoperative GnRHa treatment.

Conclusions Preoperative GnRHa treatment for women with uterine fibroids reduces preoperative fibroid size and increases hemoglobin and hematocrit levels. Gonadotropin-releasing hormone agonist pretreatment reduces preoperative pelvic symptoms and the rate of vertical incision and results in a higher chance of patients to receive a vaginal procedure, without significant difference in postoperative complications when comparing with other preoperative treatments. The patients’ age, duration of GnRHa treatment, agents selected as control, and types of surgical procedures serve as predictors of the efficacy of preoperative GnRHa treatment.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this CME activity, physicians should be better able to evaluate the efficacy of gonadotropin-releasing hormone agonist treatment before surgery for women with uterine fibroids.

*Associate Chief Physician, Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China; †Associate Chief Physician, Department of Medical Oncology, the Central Hospital of Xuzhou, the Cancer Institute of Southeast University, Xuzhou, Jiangsu, China; ‡Chief Physician, Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China; §Associate Chief Physician, Department of Gynecology and Obstetrics, Kailuan General Hospital, Tangshan, Hebei, China; ¶Chief Physician and Professor, Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.

Ying Zhang and Li Sun contributed equally to the work.

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Shuying Fan, MD, Department of Gynecology and Obstetrics, Kailuan General Hospital, #57 Xinhua East Rd, Tangshan, Hebei 063000, China. E-mail: jingtuxingzhe@126.com; and Hua Duan, MD, Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. #17 Qi He Lou St, Dongcheng District, Beijing 100006, China. E-mail: lwtgslhy@126.com.

© 2014 by Lippincott Williams & Wilkins.