Is GnRHa pre-treatment (for either 2-3 months or six months) necessary BEFORE myomectomy or hysterectomy?
The arguments FOR the pre-operative use of GnRHa are: There is strong research evidence to show that, for myomectomy or hysterectomy procedure, pre-operative GnRHa (such as Decapeptyl, Zoladex, Prostap) therapy reduces the size of fibroids and the total blood loss during the operation (i.e. less risk of need for blood transfusion). The reduced size of fibroids is particularly important for procedures like hysteroscopic myomectomy (removing the fibroids that are inside the uterus with a camera inserted via the vagina) and abdominal hysterectomy. Indeed, for abdominal myomectomy or abdominal hysterectomy, the pre-operative use of GnRHa could allow the surgeon to perform a bikini line cut instead of a midline vertical cut from the belly button. Obviously, a bikini line cut has a greater cosmetic appeal to a woman. The arguments AGAINST the pre-operative use of GnRHa are: There is concern that pre-operative GnRHa therapy may fibrose (stiffen) the skin capsule surrounding the fibroid making
