A comparison of goserelin and danazol as endometrial thinning agents prior to endometrial laser ablation
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Goserelin was more effective and better tolerated than danazol for endometrial thinning before laser ablation, yielding better surgical outcomes and menstrual control.
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Abstract
OBJECTIVE: To compare the effectiveness of goserelin and danazol prior to endometrial laser ablation and assess different dosage regimens. DESIGN: A prospective open randomised trial. SETTING: Specialist unit in minimal access gynaecological surgery in a district general hospital. PARTICIPANTS: One hundred and sixty premenopausal women with dysfunctional uterine bleeding. INTERVENTIONS: Randomisation into four groups receiving either one or two injections of goserelin acetate (3.6 mg subcutaneously) or 28 or 56 days of danazol (four 200 mg tablets daily), followed by endometrial laser ablation. MAIN OUTCOME MEASURES: Endometrial thickness pretreatment and, immediately prior to endometrial laser ablation, assessed by vaginal ultrasound and full thickness endometrial biopsy; appearance of the endometrium at surgery; duration of the operation; the amount of fluid absorbed during surgery; and the clinical outcome at 24 weeks after surgery. RESULTS: The two drugs were equally effective in thinning the endometrium. Compared with danazol, goserelin was better tolerated and resulted in a more satisfactory endometrial appearance at hysteroscopy, a greater reduction in cavity length (0.5 cm compared with 0.3 cm, P = 0.002), a shorter operation (16.4 min compared with 21.6 min, P < 0.001), less fluid absorption (0 ml compared with 200 ml, P = 0.001), and a higher rate of amenorrhoea or oligoamenorrhoea (77% compared with 54%, P < 0.001) at the six month check. The administration of goserelin for 8 weeks compared with 4 weeks produced greater thinning of the endometrium on ultrasound and on histological examination, a greater reduction in cavity length on ultrasound and an increase in reported vasomotor symptoms. In both treatment regimens, 95% of women reported a satisfactory reduction in menstrual flow at the six month check. CONCLUSIONS: Goserelin appears to be more effective and better tolerated than danazol for treatment prior to endometrial laser ablation. Eight weeks treatment with goserelin resulted in better operating conditions and more vasomotor side effect, compared with four weeks treatment, although there was no difference in clinical outcome.
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Cited by (16)
- Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding 2013
- Response of the Uterus to Medication: Hysteroscopic Implications 2009
- A randomised controlled trial comparing GnRH antagonist Cetrorelix with GnRH agonist Leuprorelin for endometrial thinning prior to transcervical resection of endometrium 2008
- Progesterone receptor modulators and the endometrium: changes and consequences† 2007
- A randomised trial comparing local <i>versus</i> general anaesthesia for microwave endometrial ablation 2003
- Chemical ablation of endometrium with trichloroacetic acid 2003
- Long-term results in the treatment of menorrhagia and hypermenorrhea with a thermal balloon endometrial ablation technique. 2003
- Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding 2002
- Evidence and techniques in endometrial ablation: consensus 2002
- Pre- and Postoperative Hormonal Treatment in Patients with Hysteroscopic Surgery 2000
- Endometrial ablation techniques 2000
- Is endometrial pre-treatment of value in improving the outcome of transcervical resection of the endometrium? 2000
- A cost effectiveness analysis of goserelin compared with danazol as endometrial thinning agents 2000
- Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: literature review 1998
- Goserelin acetate (Zoladex) plus endometrial ablation for dysfunctional uterine bleeding: a large randomized, double-blind study 1997
- Goserelin 1996
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