Use of GnRH analogues pre-operatively for hysteroscopic resection of submucous fibroids: a systematic review and meta-analysis.

GnRH analogues are commonly used before hysteroscopic myomectomy to make surgery easier and safer, but they are expensive, have potential side effects and lack a robust evidence base to support this practice. We undertook a systematic review of the literature to determine whether, in women with submucous fibroids, pre-operative GnRH analogues were more effective than placebo/no treatment in terms of symptom relief, complications and ease of surgery. The outcomes were patient-reported relief of symptoms, complete resection of the fibroids, operative time and complications. Meta-analysis was performed where appropriate. Two trials including 86 women were identified. The assessment of symptom relief differed in the two trials: hence it was not possible to combine these data. The relative risk for completion of surgery and mean differences (95% confidence intervals) for operating time and fluid deficit were [0.94 (0.68-1.31); -5.34 min, (-7.55 min to -3.12 min) and -176.2 ml, (-281.05 ml to -71.5 ml)] respectively. Our results suggest that GnRHa may improve some outcomes but there is insufficient evidence to support their routine use prior to hysteroscopic resection of submucous fibroids. More randomised trials are needed to inform definitive conclusions.