Cochrane · systematic review · CD000547
Preoperative medical therapy before surgery for uterine fibroids
Lethaby, A, Puscasiu, L, Vollenhoven, B · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Gynaecology and FertilityAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
23
No studies
7
Included studies
NR
No studies 7 · 23.3%Ungraded 0 · 0%Very low 3 · 10%Low 14 · 46.7%Moderate 5 · 16.7%High 1 · 3.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
GnRHa treatment versus placebo or no pretreatment (preoperative outcomes) for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Uterine volume (mL) (preoperative) GnRHa treatment vs placebo or no pretreatment (preoperative outcomes) | no estimate extracted | 13 studies · 858 participants | Low Downgraded: risk of bias, inconsistency |
Fibroid volume (mL) (preoperative) GnRHa treatment vs placebo or no pretreatment (preoperative outcomes) | no estimate extracted | 5 studies · 427 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Haemoglobin (g/dL) (preoperative) GnRHa treatment vs placebo or no pretreatment (preoperative outcomes) | no estimate extracted | 10 studies · 834 participants | Low Downgraded: risk of bias |
Preoperative bleeding GnRHa treatment vs placebo or no pretreatment (preoperative outcomes) | no estimate extracted | NR | No studies |
Adverse events GnRHa treatment vs placebo or no pretreatment (preoperative outcomes) | OR 2.78 [1.77, 4.36] | 4 studies · 755 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
GnRHa treatment versus no pretreatment or placebo before hysterectomy (operative and postoperative outcomes for uterine fibroids)
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of surgery (minutes) GnRHa treatment vs no pretreatment or placebo before hysterectomy (operative and postoperative outcomes | no estimate extracted | 6 studies · 617 participants | Low Downgraded: risk of bias, inconsistency |
Intraoperative blood loss (mL) GnRHa treatment vs no pretreatment or placebo before hysterectomy (operative and postoperative outcomes | no estimate extracted | 4 studies · 258 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Blood transfusions GnRHa treatment vs no pretreatment or placebo before hysterectomy (operative and postoperative outcomes | OR 0.54 [0.29, 1.01] | 6 studies · 601 participants | Moderate Downgraded: risk of bias, imprecision |
Postoperative morbidity GnRHa treatment vs no pretreatment or placebo before hysterectomy (operative and postoperative outcomes | OR 0.54 [0.32, 0.91] | 7 studies · 772 participants | Low Downgraded: risk of bias, imprecision |
GnRHa treatment versus no pretreatment or placebo before myomectomy (operative and postoperative outcomes for uterine fibroids)
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of surgery (minutes) GnRHa treatment vs no pretreatment or placebo before myomectomy (operative and postoperative outcomes | no estimate extracted | 6 studies · 443 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Intraoperative blood loss (mL) GnRHa treatment vs no pretreatment or placebo before myomectomy (operative and postoperative outcomes | no estimate extracted | 10 studies · 549 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Blood transfusions GnRHa treatment vs no pretreatment or placebo before myomectomy (operative and postoperative outcomes | OR 0.85 [0.26, 2.75] | 4 studies · 121 participants | Low Downgraded: risk of bias, imprecision |
Postoperative morbidity GnRHa treatment vs no pretreatment or placebo before myomectomy (operative and postoperative outcomes | OR 1.07 [0.43, 2.64] | 5 studies · 190 participants | Low Downgraded: risk of bias, imprecision |
GnRHa treatment versus no pretreatment or placebo before resection for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of surgery (minutes) GnRHa treatment vs no pretreatment or placebo before resection | no estimate extracted | 1 study · 39 participants | Low Downgraded: risk of bias, imprecision |
Intraoperative blood loss (mL) GnRHa treatment vs no pretreatment or placebo before resection | no estimate extracted | NR | No studies |
Blood transfusions GnRHa treatment vs no pretreatment or placebo before resection | no estimate extracted | NR | No studies |
Postoperative morbidity GnRHa treatment vs no pretreatment or placebo before resection | no estimate extracted | NR | No studies |
GnRHa treatment versus other medical therapies before any surgery for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Uterine volume (cm³) GnRHa treatment vs other medical therapies before any surgery | no estimate extracted | NR | No studies |
Fibroid volume (cm³) GnRHa treatment vs other medical therapies before any surgery | no estimate extracted | 2 studies · 110 participants | Low Downgraded: risk of bias, imprecision |
Preoperative haemoglobin (g/dL) GnRHa treatment vs other medical therapies before any surgery | no estimate extracted | 1 study · 188 participants | Moderate |
Preoperative bleeding: Reduction in bleeding to PBAC < 75 ulipristal acetate 5 mg GnRHa treatment vs other medical therapies before any surgery | OR 0.71 [0.3, 1.68] | 1 study · 199 participants | Moderate |
Preoperative bleeding: Reduction in bleeding to PBAC < 75 ulipristal acetate 10 mg GnRHa treatment vs other medical therapies before any surgery | OR 0.39 [0.14, 1.06] | 1 study · 203 participants | Moderate |
Adverse events (hot flushes) GnRHa treatment vs other medical therapies before any surgery | OR 12.3 [4.04, 37.48] | 5 studies · 453 participants | Low Downgraded: risk of bias, inconsistency |
SPRM compared to placebo for uterine fibroids
Population: women with uterine fibroids
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Uterine volume (cm³) SPRM vs placebo | no estimate extracted | NR | No studies |
Fibroid volume (cm³) SPRM vs placebo | no estimate extracted | NR | No studies |
Preoperative haemoglobin (g/dL) SPRM vs placebo | no estimate extracted | 2 studies · 173 participants | High |
Preoperative bleeding: (PBAC < 75) ulipristal acetate 5 mg SPRM vs placebo | OR 41.41 [15.26, 112.38] | 1 study · 143 participants | Low |
Preoperative bleeding: Reduction in menstrual bleeding (PBAC < 75) ulipristal acetate 10 mg SPRM vs placebo | OR 78.83 [24.02, 258.74] | 1 study · 146 participants | Low |
Preoperative bleeding: Change in menstrual blood loss from baseline to end of treatment SPRM vs placebo | no estimate extracted | 1 study · 22 participants | Low Downgraded: imprecision |
Adverse events SPRM vs placebo | OR 0.05 [0, 1] | 1 study · 241 participants | Low Downgraded: imprecision |