A woman has a 10 cm intramural fibroid with submucosal component (FIGO type 2-5) and menorrhagia. She desires uterine conservation for future fertility. Her hemoglobin is 8.2 g/dL. What is the role of GnRH agonist preoperatively?

• A GnRH agonist 3 months preoperatively reduces fibroid volume and corrects anemia, facilitating myomectomy ✓
• B GnRH agonist should be avoided as it causes hypoestrogen-related pseudocapsule thinning, increasing myomectomy difficulty
• C GnRH agonist is contraindicated before myomectomy as it causes fibroid necrosis
• D GnRH agonist converts the fibroid to a type 0 submucosal lesion, making hysteroscopic removal possible

Explanation

GnRH agonists (e.g., leuprolide) given 2–3 months preoperatively reduce fibroid volume by 30–60% and induce amenorrhea, allowing correction of iron-deficiency anemia before surgery. This can enable a vaginal/laparoscopic approach (smaller incision), reduce intraoperative blood loss, and may facilitate autologous blood donation. The pseudocapsule is actually better defined after GnRH treatment, aiding surgical dissection. The main drawback is potential increased difficulty in delineating tissue planes in very fibrous fibroids; however, overall the preoperative use is beneficial and well-supported.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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