{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T12:03:09Z","timestamp":1774526589646,"version":"3.50.1"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T00:00:00Z","timestamp":1569542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Laparoscopic myomectomy can be difficult when fibroids are large and numerous. This may result in extensive intraoperative bleeding and the need for a conversion to a laparotomy. Medical pretreatment prior to surgery might reduce these risks by decreasing fibroid size and vascularization of the fibroid. We compared pretreatment with ulipristal acetate (UPA) vs gonadotropin\u2010releasing hormone agonists (GnRHa) prior to laparoscopic myomectomy on several intra\u2010 and postoperative outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We performed a non\u2010inferiority double\u2010blind randomized controlled trial in nine hospitals in the Netherlands. Women were randomized between daily oral UPA for 12\u00a0weeks and single placebo injection or single intramuscular injection with leuprolide acetate and daily placebo tablets for 12\u00a0weeks. The primary outcome was intraoperative blood loss. Secondary outcomes were reduction of fibroid volume, suturing time, total surgery time and surgical ease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty women received UPA and 25 women leuprolide acetate. Non\u2010inferiority of UPA regarding intraoperative blood loss was not demonstrated. When pretreated with UPA, median intraoperative blood loss was statistically significantly higher (525\u00a0mL [348\u20101025] vs 280\u00a0mL[100\u2010500]; <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.011) and suturing time of the first fibroid was statistically significantly longer (40\u00a0minutes [28\u201048] vs 22\u00a0minutes [14\u201033]; <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.003) compared with GnRHa. Pretreatment with UPA showed smaller reduction in fibroid volume preoperatively compared with GnRHa (\u22127.2% [\u221235.5 to 54.1] vs \u221238.4% [\u221271.5 to \u221219.3]; <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.001). Laparoscopic myomectomies in women pretreated with UPA were subjectively judged more difficult than in women pretreated with GnRHa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Non\u2010inferiority of UPA in terms of intraoperative blood loss could not be established, possibly due to the preliminary termination of the study. Pretreatment with GnRHa was more favorable than UPA in terms of fibroid volume reduction, intraoperative blood loss, hemoglobin drop directly postoperatively, suturing time of the first fibroid and several subjective surgical ease parameters.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13713","type":"journal-article","created":{"date-parts":[[2019,8,30]],"date-time":"2019-08-30T00:34:11Z","timestamp":1567125251000},"page":"89-98","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Ulipristal acetate vs gonadotropin\u2010releasing hormone agonists prior to laparoscopic myomectomy (MYOMEX trial): Short\u2010term results of a double\u2010blind randomized controlled trial"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6683-855X","authenticated-orcid":false,"given":"Inge","family":"de Milliano","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam Reproduction and Development University Medical Center Amterdam, location VU Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith A. F.","family":"Huirne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam Reproduction and Development University Medical Center Amterdam, location VU Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas L.","family":"Thurkow","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Medical Center Amterdam location Academic Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celine","family":"Radder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology OLVG Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlies Y.","family":"Bongers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Maxima Medical Center Veldhoven The Netherlands"},{"name":"Department of Obstetrics and Gynecology GROW School for Oncology and Developmental Biology Maastricht University Medical Center Maastricht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huib","family":"van Vliet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Catharina Hospital Eindhoven The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"van de Lande","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Spaarne Gasthuis Haarlem The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"van de Ven","sequence":"additional","affiliation":[{"name":"Department of Biostatistics VU University Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter J. K.","family":"Hehenkamp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Amsterdam Reproduction and Development University Medical Center Amterdam, location VU Medical Center Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,9,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000204321.85599.0d"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.12.047"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.03.009"},{"key":"e_1_2_8_5_1","first-page":"CD000547","article-title":"Preoperative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids","volume":"2","author":"Lethaby A","year":"2001","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2011.02.010"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(12)90816-9"},{"key":"e_1_2_8_8_1","first-page":"63","article-title":"GnRH analogues and laparoscopic myomectomy","volume":"9","author":"Zullo E","year":"1997","journal-title":"Int J Gynaecol Obstet"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/14.1.44"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(00)01676-9"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1103180"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2017.02.025"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2017.10.016"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Faogs.13713","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.13713","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.13713","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.13713","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T14:06:30Z","timestamp":1694095590000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.13713"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,27]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1111\/aogs.13713"],"URL":"https:\/\/doi.org\/10.1111\/aogs.13713","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,27]]},"assertion":[{"value":"2019-02-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}