The effect of gonadotropin-releasing hormone agonists (GnRHa) on bone mineral density (BMD) in perimenopausal women undergoing hysterectomy

Abstract

To determine how the presurgical administration of gonadotropin-releasing hormone agonists (GnRHa) affects the patients' bone mineral density (BMD) and quality of life after hysterectomy. Forty-five women aged 46- 55 y/o with uterine myoma candidate for hysterectomy, consecutively have been considered to be evaluated in 2 groups in a prospective follow-up study in an university teaching hospital in Tabriz, Iran, from February 2009 to April 2012. Group one were 22 participants who received a GnRHa for 4 courses before surgery (study group) and group 2 were 23 participants (control group) with no treatment. Bone scans to appraise BMD was performed before and 6 months after the surgery. All signs and symptoms of hypo estrogenic state, pain scores and quality of life measures, were assessed. The mean changes between study group and controls in lumbar spine and hip BMD 6 months after surgery were significant [(p=0.03) and (p<0.001), respectively].The mean changes between groups in T-scores at the level of lumbar spine showed significant difference (p=0.01), but at the level of hip, it were not significant (p=0.69). The same changes between groups in Z-scores were statistically significant (p=0.019) and (p=0.008), respectively. Compared to controls in GnRHa group, low back pain increased significantly (p<0.001), and the quality of life measures was decreased. In perimenopausal women the presurgical short-term administration of GnRHa affects post-hysterectomy bone mineral density and quality of life. Hence unnecessary prescription of these drugs in this period of life should not be advocated.