GnRH analogues in the treatment of uterine fibroids.

It is now known that gonadotrophin-releasing hormone analogues (GnRHa) are extremely efficient at reducing uterine fibroid volume and reversing the related symptomatology. However, the fibroids tend to return to their pretreatment size about 6 months after discontinuing treatment. GnRHa treatment cannot be continued indefinitely due to its potential complications and high cost. It is therefore proposed that GnRHa treatment should be phase one of a two-phase treatment plan for uterine fibroids. The initial course of GnRHa should be followed by either menopause or surgery. Experience with presurgical GnRHa use indicates a definite treatment advantage and the use of GnRHa as adjuncts to surgery is well established. The value of GnRHa treatment as a alternative to surgery in pre-menopausal patients, however, remains to be established.