Use of GnRH agonists in hysteroscopic surgery

Medical reduction of the endometrium before hysteroscopic procedures has been demonstrated by many authors. In endometrial ablation, the GnRH agonists are useful for endometrial reduction and correction of anemia preoperatively. However, in cases of emergency, (severe hemorrhage), mechanical reduction (D&C) or other drugs like danazol work quicker. The GnRH agonists are more efficient in the treatment of submucous myoma, because they reduce the fibroid's size between 10 and 60% and allow reduction of endometrium and vascularization which permit easier and safer surgical procedures. After more than 300 hysteroscopic procedures for myomectomy, we now use GnRH agonists (Zoladex, Decapeptyl) 8 weeks before the procedure in fibroids type one and two. In cases of large intramural fibroids, the agonists have been administered for 12 weeks with the first surgical step at week 4 and the second step at week 12. In three cases, a third surgical step was required. In these series, no major complication occurred. We concluded that GnRH agonists are useful in hysteroscopic surgery, particularly myomectomy.