A randomized trial evaluating leuprolide acetate before hysterectomy as treatment for leiomyomas

Fifty premenopausal patients requiring hysterectomy as treatment for symptomatic uterine leiomyomas, which were the size of 14 to 18 weeks' gestation, were randomized into two groups to determine whether preoperative gonadotropin-releasing hormone agonist would increase the feasibility of vaginal rather than abdominal hysterectomy. The control group (group A; n = 25) did not receive preoperative gonadotropin-releasing hormone agonist, but patients in Group B (n = 25) received 2 months of gonadotropin-releasing hormone agonist before undergoing hysterectomy. Patients in the two groups were similar with respect to age, gravidity, parity, pretreatment uterine size, and hemoglobin and hematocrit levels. Patients in group B had an increase in hemoglobin levels (10.75 to 12.12 gm/dl, p less than 0.05) and a decrease in uterine volume (1086.7 to 723.4 ml, p less than 0.05) after 8 weeks of agonist therapy and were more likely to undergo vaginal hysterectomy (76.0% vs 16%). Patients in group B also had shorter hospitalizations (5.2 vs 3.8 days, p less than 0.05). We conclude that the administration of gonadotropin-releasing hormone agonist for 2 months followed by vaginal hysterectomy is preferable to abdominal hysterectomy in selected patients with uterine leiomyomas.