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  • Title: Hormonal inhibition of the endometrium for resectoscopic endometrial ablation.
    Author: Brooks PG, Serden SP, Davos I.
    Journal: Am J Obstet Gynecol; 1991 Jun; 164(6 Pt 1):1601-6; discussion 1606-8. PubMed ID: 1904683.
    Abstract:
    Attempts at inhibiting the thickness and vascularity of the endometrium in preparation for endometrial ablation by using different types of hormones have been reported. To evaluate the effects of two different progestins, danazol, and leuprolide acetate on the endometrium, compared with the features of early proliferative endometrium, histologic studies were done for at least five patients treated with each hormone who then underwent resectoscopic endometrial ablation for treatment of abnormal uterine bleeding. Significant and at times dramatic differences among the treatment groups were found, with progestin-prepared endometrium being the least successful and leuprolide-prepared endometrium the most successful. In addition, the prolonged suppression provided for a period of time after the procedure by depot leuprolide is likely to help inhibit endometrial regeneration and provide even better long-term success of the procedure. Four hormonal treatments to inhibit endometrial development were compared, medroxyprogesterone acetate, norethindrone, danazol and leuprolide, before resectoscopic ablation of the endometrium in 25 women with hypermenstruation. The patients all had excessive and or prolonged heavy menstrual flow not helped by curettage or combined estrogen-progestins. They ranged in age from 37-48, and none were menopausal. The pretreatments were Depo-Provera 200 mg im for 6-9 weeks, norethindrone acetate (Norlutate, Parke Davis) 5 mg daily for 6 weeks, 600 or 800 mg danazol (Danocrine, Winthrop) daily orally for 6 weeks, or leuprolide acetate (Depot Lupron, TAP Pharmaceuticals) on Day 20-24 of the cycle 4-5 weeks before ablation. The resectoscopic ablation consisted of shaving the endometrium from the cornual areas and fundal surface to the internal os to a depth of 3-4 mm with a Storz gynecologic resectoscope, size 24 Fr., with a 90 degree angle wire loop electrode, at 110 W. Histologic sections showed a fluffy decidual response to progestins such that blunt dissection or suction curettage was needed to the ablation. Danazol produced inconsistent responses from atrophy to thick deciduoid, but all had a relatively thick endometrium. Leuprolide produced a consistently thin, but not atrophic endometrium, with spindle-like fibroblast-type stromal cells, and few glands. Untreated women in early proliferative phase, Days 4-8, had atypical, thin, hypovascular endometria, with dysynchronous mild hyperplasia of some glands and stroma in some cases. Ablation was easy in untreated women. The thickness of thermally damaged tissues was 217 mm in progestin-treated women, 175 mm in danazol-treated and 141 in leuprolide-treated women. Leuprolide produced the most dependable suppression of the endometrium of the 4 drug treatments.
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