Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding in half of the studies) and publication bias (mostly commercially funded studies).
A Cochrane review included 38 studies with a total of 3623 subjects. GnRH analoges (GnRHa) treatments were associated with reductions in both uterine and fibroid volume, and increased preoperative haemoglobin, at the expense of a greater likelihood of adverse events, particularly hot flushes . Duration of hysterectomy surgery was reduced among women who received GnRHa treatment (-9.59 minutes, 95% CI 15.9 to -3.28; 6 studies, n=617) and there was less blood loss, fewer blood transfusions, and fewer postoperative complications . Selective progesterone-receptor modulators (SPRMs) (mifepristone, CDB-2914, ulipristal acetate and asoprisnil) were associated with greater reductions in uterine or fibroid volume than placebo and increased preoperative haemoglobin levels. Ulipristal acetate and asoprisnil were also associated with greater reductions in bleeding before surgery . There was no evidence of differences in preoperative complications or in severe adverse events.
| Outcome | Relative effect (95% CI) | Assumed risk - Control -Placebo or no treatment | Corresponding risk - Intervention - GnRHa pretreatment (95% CI) | No of Participants (studies) Quality of evidence |
|---|---|---|---|---|
| Uterine volume (mL) (mean, preoperative) | - | 255 mL to 920 mL | 175.34 mL lower (219.04 mL to 131.65 mL lower) | 858 (13) Low |
| Haemoglobin (g/dL) (mean, preoperative) | - | 10.9 g/dL to 13.4 g/dL | 0.88 mL higher (0.68 mL to 1.08L higher) | 834 (10) Low |
| Adverse events | OR 2.78 (1.77 to 4.36) | 608 per 1000 | 812 per 1000 (733 to 871) | 755 (4) Moderate |
| Blood transfusions before hysterectomy | OR 0.54 (0.29 to 1.01) | 115 per 1000 | 66 per 1000 (36 to 116) | 601 (6) Moderate |
| Hysterectomy: Postoperative morbidity | OR 0.54 (0.32 to 0.91) | 239 per 1000 | 145 per 1000 (91 to 222) | 772 (7) Low |
| Blood transfusions before myomectomy | OR 0.85 (0.26 to 2.75) | 194 per 1000 | 170 per 1000 (59 to 398) | 121 (4) Low |
| Myomectomy: Postoperative morbidity | OR 1.07 (0.43 to 2.64) | 188 per 1000 | 199 per 1000 (91 to 379) | 190 (5) Low |
| Outcome | Relative effect (95% CI) | Assumed risk - Control - Placebo | Corresponding risk - Intervention - SPRM (95% CI) | No of Participants (studies) Quality of evidence |
|---|---|---|---|---|
| Preoperative haemoglobin (g/dL, mean) | - | 12.2 to 12.6 | 0.93 higher (0.52 to 1.35 higher) | 173 (2) High |
| Preoperative bleeding: (PBAC < 75) ulipristal acetate 5 mg | OR 41.41 (15.26 to 112.38) | 188 per 1000 | 906 per 1000 (779 to 963) | 143 (1) Low |
| Preoperative bleeding: Reduction in menstrual bleeding (PBAC < 75) ulipristal acetate 10 mg | OR 78.83 (24.02 to 258.74) | 83 per 1000 | 877 per 1000 (685 to 959) | 146 (1) Low |
Date of latest search: 2018-02-07