Uterine resectoscopic myomectomy with and without microrelin pretreatment: a single-blinded randomized clinical trial. Abbas Norouzi Javidan 1 , Mina Jafarabadi 2* , Sahar Latifi 1 , Masoumeh Farhadkhani 1 , Mansoureh Gorginzadeh 2 1 Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Iran 2 Reproductive Health Research Center, Tehran University of Medical Sciences, Iran Abstract Study objective: To assess the outcomes of surgery in the group of patients who were submitted to pre- operative GnRH agonists in comparison with those who received no medication. The levels of gonadotropin hormones (LH and FSH) and estradiol, which were measured 2 and 12 weeks after treatment, were also compared between two groups. Design: Single-blinded randomized clinical trial. Design classification: Canadian Task Force Classification I. Setting: University hospital. Patients: A total of 60 patients participated in this clinical trial. Inclusion criteria were: age between 18-50 y (premenopausal women). Interventions: Sixty patients were assigned randomly to intervention and control group. Intervention group received three doses of monthly intramuscular injections of Microrelin 3.75 mg (a sustained release formulation of triptorelin) before hysteroscopic myomectomy and control group received no medications. Uterine resectoscopic myomectomy was performed in both groups. Measurements and main results: Operation characteristics including operation time and amount of absorbed fluid were measured. Level of difficulty and satisfaction from surgeon’s view were assessed based on Visual Analog Scale (VAS). Serum levels of LH, FSH and estradiol were measured at the baseline and after 2 and 12 weeks in both groups. A total of 60 patients participated in this clinical trial. The sizes of myomas were significantly reduced in microrelin group in comparison with control group (33% reduction, p<0.0001). The administration of Microrelin led to significant reduction of estradiol, LH and FSH levels after 12 weeks. However a transient flare-up in the level of estradiol was detected after 2 weeks. The satisfaction level from operation from surgeon’s view was significantly higher (p=0.01) and the level of difficulty was lower in Microrelin group (p=0.049). No significant difference in haemoglobin drop after operation was detected between two groups. Conclusion: Our study showed that pretreatment with Microrelin before uterine resectoscopic myomectomy could lead to less surgical difficulties and subsequently lower operation time. The amount of haemoglobin (as an indicator of blood loss) was not affected with this intervention. Our study supports the beneficiary influence of GnRH agonists in outcomes of myomectomy. Keywords: GnRH agonist, Myoma, Myomectomy, Clinical trial. Accepted on June 08, 2017 Introduction Uterine leiomyomata are the most frequent benign tumour of uterus and is considered to be the most common cause of uterine surgery [1,2]. It has been previously reported that pretreatment with Gonadotropin Releasing Hormone (GnRH) analogs reduces the size of myomas and facilitate hysteroscopic surgery [3,4]. However, the numbers of randomized clinical trial confirming this beneficiary effect of GnRH analogs are so restricted. Some studies have supported the advantages of administration of GnRH analogs before operation since these medications have the potential to decrease the volume of distension fluid and the overall surgical time, but some other literatures have shown that these analogs may increase the recurrence of myomas because they make small myomas less visible during the surgery [5,6]. The growth of leiomyomas are stimulated by sex steroid hormones and therefore prescription of GnRH agonists leads to suppression of pituitary ovarian function which helps to temporary control of bleeding and correction of iron deficiency anaemia [2,7,8]. However, as these analogs may sometimes ISSN 0970-938X www.biomedres.info Biomedical Research 2017; 28 (16): 6963-6967 6963 Biomed Res- India 2017 Volume 28 Issue 16