IMR Press / CEOG / Volume 48 / Issue 6 / DOI: 10.31083/j.ceog4806200
Open Access Review
The role of hormone therapy before hysteroscopic myomectomy
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1 Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy
2 Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, Italy
Clin. Exp. Obstet. Gynecol. 2021, 48(6), 1259–1266; https://doi.org/10.31083/j.ceog4806200
Submitted: 15 August 2021 | Revised: 26 September 2021 | Accepted: 20 October 2021 | Published: 15 December 2021
(This article belongs to the Special Issue Updates in Obstetrics and Gynecology)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Abstract

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 Non-Indexed 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
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