The role of hormone therapy before hysteroscopic myomectomy

Abstract

The role of hormone therapy before hysteroscopic myomectomy Antonio Simone Laganà1, *, Susan Dababou2 , Mariachiara Bosco2 , Pier Carlo Zorzato2 , Paola Pomini2 , Rossana Di Paola2 , Stefano Uccella2 , Ricciarda Raffaelli2 , Massimo Franchi2 1Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy 2Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, Italy *Correspondence: antoniosimone.lagana@uninsubria.it (Antonio Simone Laganà) DOI:10.31083/j.ceog4806200 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 15 August 2021 Revised: 26 September 2021 Accepted: 20 October 2021 Published: 15 December 2021 Objective: This review analyzes the preoperative treatments used before hysteroscopic myomectomy, trying to identify the main indications for each option. Methods: a comprehensive search of several databases was conducted from inception up to May 2021. The searched databases were MEDLINE, In-Process & Other NonIndexed Citations, Daily, Ovid EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. The search strategy included the combinations of the following medical terms: Hysteroscopic myomectomy; Uterine fibroid, Hormonal therapy, preoperative. We selected clinical studies, systematic reviews, and meta-analyses in English to investigate hormone therapy before hysteroscopic myomectomy. We opted for a narrative synthesis of the results, summarizing the evidence provided by the most relevant studies to offer the reader a complete and synthetic overview of the topic. Findings in brief : The hormonal therapies preoperatively used to prepare the endometrium before a hysteroscopic procedure are gonadotropins releasing hormone (GnRH) analog, danazol, progestogen, and combined oral contraceptives. On the one hand, the efficacy of GnRH analogs and danazol administration before hysteroscopic surgery has been demonstrated by several studies, mainly related to the time of surgery and volume of distension medium absorbed. On the other hand, although the evidence is more limited, progestogens and combined hormonal contraceptives have proven a comparable efficacy in achieving adequate endometrial thinning. Conclusions: To date, no definitive data provide strong evidence towards one specific preoperative therapy before myomectomy hysteroscopy. Several variables should be considered using a specific medical therapy (including the different potential effects with a particular drug compared to the others in type 0, 1, or 2 myoma); this element further amplifies the heterogeneity of the available findings in the literature and does not allow to draw a firm conclusion about a best pharmacological management over the others. Keywords Hysteroscopy; Hysteroscopic myomectomy; Uterine fibroid; Hormonal therapy; Endometrium