A prospective randomized trial of the effect of preoperative endometrial inhibition on the long‐term outcome of transcervical endometrial resection

Objective To determine the effect of preoperative hormonal inhibition of the endometrium on the long‐term results of transcervical endometrial resection. Design A prospective randomized trial. Setting Gynaecology department of a district general hospital. Subjects 77 women undergoing transcervical endometrial resection between January 1992 and December 1993 were randomized to either no endometrial preparation or pretreatment with two injections of goserelin, 3.6 mg, 4 weeks apart prior to surgery. Another 58 women who declined entry into the trial were given danazol, 800 mg per day, for 6 weeks preoperatively, and were also contacted postoperatively to assess the outcome of surgery. Main outcome measures Postoperative menstrual loss, dysmenorrhoea, patient satisfaction and the need for any further surgery were assessed by postal or telephone questionnaire at between 12 and 33 months after surgery. Results A significantly higher proportion of women treated preoperatively with goserelin had amenorrhoea postoperatively when compared with those who had no pretreatment (57.1 vs. 22.5%; P <0.01). Overall postoperative menstrual loss was also significantly less in the pretreatment group. The proportion of women with no postoperative dysmenorrhoea was greater in those who had received preoperative goserelin (57.1 vs. 35.0%) but did not reach significance ( P =0.08). Patients treated with danazol preoperatively showed a similar but nonsignificant pattern when compared with women receiving no pretreatment. Patient satisfaction and the proportion of women subsequently having a hysterectomy was similar in each of the three groups. Conclusions Endometrial inhibition with goserelin prior to transcervical endometrial resection results in significantly higher rates of postoperative amenorrhoea. It may also reduce postoperative dysmenorrhoea and overall postoperative menstrual loss. However, patient satisfaction and subsequent hysterectomy rate is unaffected by preoperative endometrial inhibition.