(1) The reference treatment for uterine
leiomyoma with major symptoms is surgery. (2)
Leuprorelin and
triptorelin, two
Gn-RH analogues, are the first drugs to be licensed in France for preoperative treatment of uterine
leiomyoma associated with anaemia, when a reduction in the size of the
leiomyoma is necessary to facilitate or modify the surgical technique. (3) A double-blind placebo-controlled trial of
leuprorelin in nearly 300 anaemic women showed no advantage in terms of the need for non autologous transfusion. (4) Three double-blind placebo-controlled trials have shown that
leuprorelin reduces the volume of uterine
leiomyomas, but whether or not this facilitates or modifies the surgical technique is not known. An unblinded trial versus
lynestrenol in non anaemic women showed a superior effect of
leuprorelin on the size of the
leiomyoma, but again there were no data on a possible effect on the choice of surgical technique. (5) In the absence of comparative double-blind trials, the observed effects of
triptorelin on the choice of surgical technique are uninterpretable. (6) The adverse effects of
leuprorelin are mainly linked to its
hormone effect, i.e.
flushing,
headache,
vaginitis and vaginal dryness. There are no recent reviews of the adverse effects of
triptorelin in this setting. (7) In practice, for anaemic women with
leiomyomas requiring surgery, there is no proof that
leuprorelin and
triptorelin have any tangible clinical advantages.