SYMPTOMATIC UTERINE FIBROID TREATMENT: A PILOT STUDY BETWEEN A LONG ACTING GNRH ANTAGONIST AND AN ORAL GNRH ANTAGONIST

Uterine fibroids are the most common neoplasm in women, and they are the leading indication for hysterectomy. Their symptoms are heavy menstrua bleeding, pain, pelvic pressure, bowel and/or bladder dysfunction and reproductive problems. Several treatments may be used to treat the symptomatic uterine fibroid, surgical or medical. In this study we evaluated in a pilot study the efficacy of a long acting GnRh antagonist compared with an oral GnRH antagonist in the treatment of symptomatic fibroids. A total of 53 symptomatic patients were enrolled in the study: inclusion criteria were uterine volume more than 300cm3, heavy menstrual bleeding, hemoglobin less than 12mg/100ml. Exclusion criteria were coagulopathy, systemic diseases, diabetes, menopause, childbearing. A total of 27 women were treated with Degarelix 120mg, subcutaneously only once, and 26 women were treated with relugolix 40mg/estradiol 1mg/ norethisterone acetate 0.5mg/day orally for 20 weeks. The women of the two groups were followed up during the treatment, undergoing to serial the assessment ultrasound scan to assess uterine and fibroids dimensions as well as side effects record. The two groups of patients did not show statistically significant differences for any epidemiological data. At the end of treatment (4 months) the heavy bleeding disappeared in both groups of patients, but the uterine volume was statistically significant more reduced in the Degarelix group than in the relugolix group (52.1%+18.8:P<0.0001). The higher reduction in the Degarelix group was still observed after 4 months from the end of therapy (42.9%+15.8 vs 8.7%+7.9: P<0.0001). After 4 months from the end of therapy the bleeding recurred in 16 women out of 26 treated with Relugolix group and only in two of Degarelix group (P<0.001). The side effects rate observed was similar in the two groups. The treatment of uterine fibroids with Degarelix showed better results than relugolix/estradiol/norethisterone acetate group with a bigger fibroids dimension reduction and lower rate of symptom recurrence. Degarelix may be the treatment of choice in symptomatic uterine fibroids.