Endometrial ablation for dysfunctional uterine bleeding: Role of GnRH agonists

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Abstract
To discuss a new alternative to treat patients with dysfunctional uterine bleeding who fail to respond to hormonal treatments, and to outline the role of GnRH analogs in the presurgical preparation of these patients. The causes and various hormonal treatments of dysfunctional uterine bleeding are outlined, and various methods of endometrial ablation, with hormonal and non-hormonal preparations, are reviewed, In endometrial ablation, while hormonal preoperative treatments are more advantageous than no endometrial suppression, GnRH analogs prepare the endometrium better by reducing thickness uniformly, decreasing edema, and avoiding pseudo-decidual reaction usually present with other hormonal treatments. Because success of endometrial ablation seems to correlate with uniform destruction of endometrium and superficial portion of myometrium, thinning of the endometrium hormonally simplifies the procedure, adds in the overall success of endometrial ablation, and reduces additional blood loss by controlling the bleeding preoperatively.