Preoperative Medication for Fibroid Reduction

Introduction to GnRH Agonists

The American College of Radiology recommends GnRH agonist injection as the most appropriate preoperative medication for fibroid reduction prior to myomectomy, as it significantly reduces fibroid and uterine volume before surgery 1

GnRH agonists reduce uterine volume and achieve up to 50% reduction in fibroid volume over 3 months of treatment, making surgical myomectomy technically easier with improved visualization and reduced operative complexity 1
Administering GnRH agonist for 3-4 months prior to surgery achieves maximal fibroid volume reduction 1

Consider adding hormone add-back therapy (low-dose estrogen-progestin) if treatment extends beyond 3 months to prevent bone mineral density loss 2
Concurrent iron supplementation should be provided to optimize preoperative hemoglobin 3

Oral contraceptive pills are effective for managing bleeding symptoms but do not reduce fibroid size, and are first-line therapy for symptom control in women with small fibroids, not for preoperative volume reduction 1, 4
Levonorgestrel IUDs are the most effective first-line treatment for reducing menstrual blood loss but do not shrink fibroids, and address bleeding symptoms only, not surgical preparation 2, 3, 4
Progestins may help with bleeding control but lack evidence for significant fibroid volume reduction needed for surgical preparation, and are not recommended as preoperative therapy for myomectomy 1, 2

Fibroids rapidly return to pretreatment size after GnRH discontinuation, so surgery should be scheduled promptly after completing the 3-4 month course 1, 2
Fertility is suppressed during GnRH treatment but returns after cessation 2