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Obstetrical & Gynecological Survey:
doi: 10.1097/OGX.0000000000000036
CME Articles

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

Continued Medical Education
Erratum

Erratum

In the article that appeared on pages 100–108 of the February issue, Dr. Zhang’s name appears incorrectly. The proper name is Ying Zhang.

The author apologizes for this error.

Obstetrical & Gynecological Survey. 69(10):628, October 2014.

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Abstract

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.

© 2014 by Lippincott Williams & Wilkins.

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