To compare the usefulness of vaginal danazol and diphereline in the management of intra-operative bleeding during hysteroscopy.
Randomized controlled clinical trial.
One hundred and ninety participants of reproductive age were enrolled for operative hysteroscopy. Thirty women were excluded from the study.
One hundred and sixty participants with submucous myomas were allocated at random to receive either vaginal danazol (200 mg BID, 30 days before surgery) or intramuscular diphereline (twice with a 28-day interval).
Main outcome measures
Severity of intra-operative bleeding, clarity of the visual field, volume of media, operative time, success rate for completion of operation and postoperative complications.
Overall, 145 patients completed the study. In the danazol group, 78.1% of patients experienced no intra-operative uterine bleeding, and 21.9% experienced mild bleeding. In the diphereline group, 19.4% of patients experienced no intra-operative uterine bleeding, but mild, moderate and severe bleeding was observed in 31.9%, 45.8% and 2.8% of patients, respectively. The difference between the groups was significant (p < 0.001). A clear visual field was reported more frequently in the danazol group compared with the diphereline group (98.6% vs 29.2%, p < 0.001). The mean operative time was 10.9 min and 10.6 min in the danazol and diphereline groups, respectively (p = 0.79). The mean volume of infused media was 2.0 L in both groups (p = 0.99). The success rate was 100% for both groups with no intra-operative complications.
Both vaginal danazol and diphereline were effective in controlling uterine bleeding during operative hysteroscopy. However, vaginal danazol provided a clearer visual field.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- What to do when she's bleeding through: the recognition, evaluation, and management of abnormal uterine bleeding in adolescents.Curr Opin Pediatr. 2014; 26: 413-419
- The practicability and surgeons’ subjective experiences with vaginal danazol before an operative hysteroscopy.Steroids. 2012; 77: 528-533
- GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study.Fertil Steril. 2010; 94: 1496-1499
- Comparison of the effect of gonadotropin-releasing hormone analog (Diphereline) and Cabergoline (Dostinex) treatment on uterine myoma regression.Saudi Med J. 2007; 28: 445-450
- Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study.Fertil Steril. 2007; 88: 698-701
- Clinical utility of ulipristal acetate for the treatment of uterine fibroids: current evidence.Int J Womens Health. 2015; 7: 321-330
- Gestrinone versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation.Fertil Steril. 2006; 85: 1027-1031
- Hysteroscopic myomectomy: is there a place for pretreatment with GnRH agonist?.WJOLS. 2009; 2: 53-56
- Abnormal uterine bleeding: medical treatment with vaginal danazol and five-year follow-up.J Am Assoc Gynecol Laparosc. 2004; 11: 340-343
- Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis.Fertil Steril. 2007; 88: 789-794
- Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding.Cochrane Database Syst Rev. 2013; 11: CD010241
- An open and randomized study comparing the efficacy of standard danazol and modified triptorelin regimens for postoperative disease management of moderate to severe endometriosis.Fertil Steril. 2004; 81: 1522-1527
- A Danazol-loaded intrauterine device decreases dysmenorrhea, pelvic pain, and dyspareunia associated with endometriosis.Fertil Steril. 2004; 82: 239-240
- Short-term and long-term results of resectoscopic myomectomy with and without pretreatment with GnRH analogs in premenopausal women.Acta Obstet Gynecol Scand. 2005; 84: 756-760
- Treatment with a gonadotrophin releasing hormone agonist before endometrial resection: a multicentre, randomised controlled trial.Br J Obstet Gynaecol. 1996; 103: 562-568
- Reduction of menstrual blood loss by danazol in unexplained menorrhagia: lack of effect of placebo.Br J Obstet Gynaecol. 1980; 87: 1152-1158
- Medical treatment in abnormal uterine bleeding: evaluation of a GnRH therapy versus danazol therapy in perimenopausal women.Minerva Ginecol. 2002; 54: 499-504
- A randomized, comparative trial of triptorelin depot (D-Trp6-LHRH) and danazol in the treatment of endometriosis.Eur J Obstet Gynecol Reprod Biol. 1995; 59: 61-69
- Hormonal inhibition of endometrium for transcervical endometrial ablation – a prospective study with a 2-year follow-up.Eur J Obstet Gynecol Reprod Biol. 1997; 74: 201-203
- Is endometrial pre-treatment of value in improving the outcome of transcervical resection of the endometrium?.Hum Reprod. 2000; 15: 1989-1992
- Novel vaginal danazol ring therapy for pelvic endometriosis, in particular deeply infiltrating endometriosis.Hum Reprod. 1998; 13: 1952-1956
- Efficacy of vaginal danazol treatment in women with menorrhagia during fertile age.Fertil Steril. 2009; 92: 1351-1354
- Lobato E.B. Gravenstein N. Kirby R.R. Complications in anesthesiology. Lippincott Williams & Wilkins, Philadelphia2008
Published online: November 26, 2015
Accepted: October 28, 2015
Received in revised form: October 20, 2015
Received: May 12, 2015
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.