Preoperative medical therapy before surgery for uterine fibroids

Summary

A Cochrane review «Preoperative medical therapy before surgery for uterine fibroids»1 «Puscasiu L, Vollenhoven B, Nagels HE, et al. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev 2025;4(4):CD000547. »1 included 41 studies with a total of 3982 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 «GnRHa treatment versus placebo or no pretreatment for uterine fibroids»1. Duration of hysterectomy surgery was reduced among women who received GnRHa treatment (-10.11 minutes, 95% CI -16.96 to -3.25; 6 studies, n=617) and there was less blood loss, fewer blood transfusions, and fewer postoperative complications «GnRHa treatment versus placebo or no pretreatment for uterine fibroids»1. 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 «Selective progesterone-receptor modulators (SPRM) compared to placebo for uterine fibroids»2. There was no evidence of differences in preoperative complications or in severe adverse events.