Abstract
Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials. Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese. The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis. Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person. The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.80-1.11); operative time (mean difference [MD]: - 3.81; 95%CI : - 3.81-2.13); fluid absorption (MD: - 65.90; 95%CI: - 9.75-2.13); or complications (RR 0.92; 95%CI: 0.18-4.82). The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.
Highlights
Uterine myomas are the most common benign tumor of the female genital tract.[1]
Four clinical trials were included in the meta-analysis
It is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size
Summary
Uterine myomas are the most common benign tumor of the female genital tract.[1]. Myomas could be classified into subserous, intramural, and submucous types according to their location in the uterus. Clinical presentation of the submucous myoma includes menorrhagia, metrorrhagia, dysmenorrhea, infertility, and repeated abortion.[2,3]. The surgery goal is the complete removal of the fibroid – reducing the chance of recurrence and regrowth.[3] Submucous fibroids distort the endometrial cavity and typically cause heavy or irregular menstrual bleeding.[4] The advantages of hysteroscopic resection of submucous myomas are reduced trauma, shorter hospitalization and recovery times, as well as decreased risk of adhesion formation. Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas ( rendering surgery faster), but robust evidence to support this practice is weak.[5]
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