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Why do GnRH Agonist Treated Leiomyomata Shrink?
Title: Pathologic changes in gonadotropin releasing hormone agonist analogue treated leiomyomata Author: Deligdisch,L. et al
Address: New York, New York
Source: Fertility and Sterility; 67:837-841,1997 (May)
Synopsis: The mechanism of shrinkage has no precise or satisfying explanation. This 30 patient study analyzes the pathologic changes observed in leuprolide acetate (Lupron) treated leiomyomata. PatientÕs ages 31-53 years treated with Lupron 3.75 mg/mo for 3 months (10 hysterectomies and 20 myomectomies) were matched with 30 control patients (8 hysterectomies and 22 myomectomies). The largest 2-3 fibroids were sampled and revealed confluent nodular hyaline and hydropic degeneration representing a scarlike retraction and obliteration of the interface between myoma and myometrium were found in higher proportions in the treated patients. Differences in cellularity, nuclear atypia, and edema were not statistically significant. Researchers concluded that the decrease in size of the treated leiomyomata is similar to that of the hypoestrogenism of the after menopause.
Comment: Although some of the previous data has been suspect, it appears that Lupron causes a universal significant reduction in the fibroid. It may also give a period of amenorrhea that will allow hematocrit to improve in patients with severe anemia. It also seems valuable for hysterscopic, and possibly laparoscopic, resection due to less blood loss. This must be weighed by cost, menopausal side effects, possible pain with degeneraton, and postponement of surgery. It has been my experience that while bleeding is less, removal of fibroids myomectomy is more difficult. This is consistent with the above findings of loss of definition between the fibroid capsule and myometrium. Physicians probably should perform enough cases using GnRH analogs in the treatment of fibroids to draw conclusions from their direct experience.
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