Uterine artery embolization of large fibroids: Comparative study of procedure with and without pretreatment gonadotropin-releasing hormone agonists

OBJECTIVE. The purpose of this study was to evaluate the safety of pretreatment with gonadotropin-releasing hormone (GnRH) agonists before uterine artery embolization (UAE) of large fibroids. MATERIALS AND METHODS. The cases of 40 patients with large fibroids (≥ 10 cm) were retrospectively analyzed. Among the 40 patients, 28 (control group) underwent UAE without pretreatment with GnRH agonists, and 12 (GnRH group) received GnRH agonists 1-5 times before UAE. MRI was used to assess necrosis of large fibroids and their volumes in both groups within 3 months after UAE. RESULTS. Complete necrosis of large fibroids after UAE was achieved in 39 of 40 patients (97.5%). Only one patient, who was in the control group, had incomplete necrosis of the predominant fibroid. When GnRH agonists were administered before UAE, the mean volume reduction rate of fibroids was 36.3%. The final mean volume reduction rates of the predominant fibroids and the uterus after UAE in the GnRH group were 56.5% (range, 38-79%) and 50.8% (range, 35-72%), significantly higher than the volume reduction rates of 35.1% (range, 7-65%) and 34.9% (range, 16-54%) in the control group (p < 0.001). Grade D complications were not seen in the GnRH group but occurred in four patients in the control group. CONCLUSION. Pretreatment with GnRH agonists before UAE of large fibroids was safe for patients with large fibroids and did not prevent performance of UAE.