Treatment with GnRH agonists before myomectomy and the risk of short-term myoma recurrence
Uterine leiomyomas (fibroid tumors) are noncancerous smooth muscle tumors found in the uterus. Symptoms include pain, abnormal bleeding and infertility. A myomectomy is a surgical technique of removing the tumors (myomas), while maintaining the integrity of the uterus. It is thought that if uterine myomas could be reduced in size prior to surgery, the amount of bleeding that occurs after the operation could be reduced. A new class of drugs called gonadotropin releasing hormone (GnRH) agonists mimic gonadotropin releasing hormones produced in the brain. Treatment with GnRH agonists prevents the release of estrogen, which is thought to influence the size of the tumors. To see if pretreatment with the GnRH agonist buserelin (1,200 micrograms per day) is useful in reducing postoperative bleeding, surgical complications, and myoma recurrence, 24 women were evaluated. Eight women received buserelin by nasal spray three months prior to surgery, and 16 women had no prior treatment. The size of the tumors were assessed by ultrasonographic imaging of the uterus before and after treatment. Presurgical treatment with GnRH agonists reduced the total volume of the uterus from 432 to 242 milliliters. There were no differences in the amount of postoperative blood loss, fever, and complications between the two groups. When the women were examined six months after the operation, small myomas (less than 1.5 centimeters) returned in five women who received buserelin (63 percent), and in two women who had no presurgical treatment (13 percent). However, it is thought that pretreatment with buserelin made these myomas so small they were not identifiable during the initial operative exploration. Therefore, the presence of myomas six months later was not associated with recurrence of symptoms, but with previously undetected myomas. The significance of minimal tumors found during follow-up ultrasound examination requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Obstetrics and Gynecology
Buserelin versus danazol in the treatment of endometriosis-associated infertility
Endometriosis is a condition in which endometrial tissue, the cells lining the inside of the uterus, become implanted in other parts of the body. It can cause pain, bleeding and infertility. Although the disease is not well understood, it is thought that menstrual blood carrying endometrial cells flows backwards into the fallopian tubes and out into the abdominal cavity. Treatment is aimed at reducing the amount of the sex steroid hormone estrogen, which reduces the response of endometrial tissue. Danazol, a drug which blocks the production of the hormones, is used to treat patients with endometriosis. Gonadotropin-releasing hormone (GnRH) agonists, drugs which block the production of GnRH, have also been shown to be an effective treatment. A diagnosis of endometriosis was made in 62 infertile women, who were divided into two groups receiving either danazol or a GnRH agonist, buserelin. Reduction of estrogen was greatest in the group receiving buserelin. Laparoscopy, in which a small tube affixed with a magnifying lens is inserted into a surgical opening in the abdomen to visualize internal structures such as the uterus, fallopian tubes and peritoneal (abdominal) cavity, was used to evaluate treatments in 13 danazol-treated patients and 12 buserelin-treated patients. There were no differences between the two treatments at follow-up laparoscopic examination of the endometrial implants. Pregnancy was achieved in 48 percent of the infertile patients treated with buserelin and 43 percent treated with danazol. The pain of endometriosis returned after one year in 50 percent of the patients receiving either treatment. Fewer side effects were reported in the buserelin-treated group. The buserelin treatment was found to be as effective as danazol with respect to improved fertility.
Publication Name: American Journal of Obstetrics and Gynecology
Pelvic denervation for chronic pain associated with endometriosis: fact or fancy?
Endometriosis, growth of endometrial tissue (uterine lining) in areas other than the uterus, may be associated with chronic pelvic pain. Conservative treatment of the disease mostly focuses on maintaining a woman's fertility; the appropriate treatment of pain for a woman who wish to bear children is disputed. Until the 1960s, resection of pelvic nerves was commonly used to treat women with painful menstruation or pain caused by disease. This became less popular with increased use of non-steroidal anti-inflammatory drugs. However, interest in denervation has recently revived, as drug therapy for endometriosis seems limited. Reports on the surgical treatment of pelvic pain were analyzed to better understand the appropriateness of the treatment. Studies have often not been rigorously performed, so conclusions are difficult to obtain. Often the severity of endometriosis is not considered in the studies. One study suggested that pain in the midline of the body was effectively relieved by denervation. However, endometriosis is rarely associated with pain only in the midline. Pain relief is not guaranteed by the surgery, whether done traditionally or by laser, and complications may be great, as important blood vessels and nerves pass close to the operated area. Studies do not support that nerve resection provides more pain relief than simple removal of endometriotic tissue. Further study is needed to prove the value of such surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Obstetrics and Gynecology
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