Goserelin acetate (Zoladex) plus endometrial ablation for dysfunctional uterine bleeding: a large randomized, double-blind study.

OBJECTIVE: To confirm the advantages of goserelin prior to endometrial ablation for the treatment of dysfunctional uterine bleeding. DESIGN: Multicenter, prospective, randomized, double-blind study. PATIENT(S): Cycling premenopausal women with dysfunctional uterine bleeding. TREATMENT: Patients were randomized to goserelin or placebo (sham depot) once monthly for 2 months prior to endometrial ablation. Treatment was timed to allow surgery 6 weeks later on day 7 of the menstrual cycle. MAIN OUTCOME MEASURE(S): Amenorrhea rates, endometrial histology and thickness, pain and blood loss scores, and surgical parameters. RESULT(S): At 24 weeks after surgery, significantly more goserelin than placebo patients experienced amenorrhea (40% versus 26%). Blood loss was reduced from baseline, but not different between the groups. At surgery, mean endometrial thickness was 1.6 mm and 3.4 mm for the goserelin and placebo groups, respectively, with significantly more atrophic glands and stroma in the goserelin group. Surgery was significantly shorter (by 22%) and easier in the goserelin than in the placebo group, with a significantly lower median fluid absorption in the goserelin groups. In both groups, pain scores were reduced patient satisfaction was high (> 92%), and re-intervention rate was low (2.8%). CONCLUSION(S): Goserelin in combination with endometrial ablation was superior to endometrial ablation alone for the treatment of dysfunctional uterine bleeding.

Second-trimester abortion by extra-amniotic instillation of Rivanol combined with intravenous administration of oxytocin or prostaglandin F2 alpha.

Induction of second-trimester abortion was studied by administration of the acridine derivative Rivanol in combination with an i.v. drip infusion of oxytocin or prostaglandin F2 alpha (PG2 alpha), alone or in combination. It was found that an early onset of the i.v. infusion was of major importance for the outcome. Administration of oxytocin in immediate connection with the Rivanol instillation proved more favorable than administration of PGF2 alpha) or a combined oxytocin PGF2 alpha drip, taking into consideration the induction-abortion time as related to the side effects. A lag phase between the instillation of Rivanol and the start of i.v. infusion such as has earlier been frequently recommended seemed to be of no specific advantage, but caused both a prolonged induction-abortion time and an increased incidence of infection.

PIP: Induction of 2nd trimester abortion was studied by administration of the acridine derivative Rivanol in combination with an intravenous (iv) drip infusion of oxytocin or prostaglandin (PGF2alpha), alone or in combination. It was found that an early onset of the iv infusion was of major importance for the outcome. Administration of oxytocin in immediate connection with the Rivanol instillation proved more favorable than PGF2alpha administration or a combined oxytocin/PGF2alpha drip, taking into consideration the induction-abortion time as related to side effects. A lag phase between Rivanol instillation and the start of the iv infusion such as has earlier been frequently recommended seemed to be of no specific advantage, but caused both a prolonged induction-abortion time and an increased incidence of infection.