The Place of GnRH Agonists in the Treatment of Endometriosis and Fibroid by Advanced Endoscopic Techniques

Uterine fibroids and endometriosis are common benign diseases of the female genitals. Fibroids are commonly associated with infertility and/or menorrhagia, especially if they are submucosal. Endometriosis is diagnosed in more than 35% of patients undergoing a laparoscopy for infertility. Both diseases are oestrogen-dependant and suppression of the secretion of gonadal steroids by administration of a superactive agonist of LH-RH has been proposed as the non-surgical approach to fibroids and endometriosis. Because most leiomyomata and endometriotic cysts return to near pretreatment size within 4 months after cessation of GnRH-a therapy, these agents cannot be used as difinitive medical therapy but must be considered as an ad juvant for preoperative-reduction of tumor size. Because the GnRH-a therapy induces a menopausal status, it cannot be used during a prolonged period. The principal purpose is to obtain a preoperative reduction of the tumor size so that surgical treatment using endoscopic techniques is possible: 1) hysteroscopic myomectomy in cases of submucosal fibroid. 2) laser vaporization of large endometrial cysts.