Response to Leuprolide Acetate in Surgical Management of Large Uterine Fibroids

INTRODUCTION: Leuprolide acetate may be a useful adjunct in preoperative treatment of large uterine fibroids to allow a minimally invasive surgical approach, although research to support this practice is limited. OBJECTIVE: This study aims to evaluate the clinical response to preoperative depot LA in patients with large fibroids, focusing on changes in uterine size and symptom improvement across different surgical approaches. METHODS: A retrospective chart review was performed from 2019 to 2024 at three tertiary care institutions. Patients with at least one fibroid greater than 5 cm who received LA more than 1 month prior to surgical intervention were included. Patients with malignancy and without preoperative imaging were excluded. The primary outcome was overall response to LA. In patients undergoing hysterectomy, this was measured by change in uterine weight in grams from preoperative imaging to uterine specimen weight. In patients undergoing conservative procedures, change in fundal height and improvement in bleeding or bulk symptoms were used to assess LA response. Patient characteristics and outcomes were summarized with descriptive statistics. RESULTS: A total of 95 patients were included; mean age was 40.8, and mean BMI 30.9. The majority of patients experienced abnormal bleeding (65.3%) and bulk symptoms (66.3%). Patients received LA an average of 90 days prior to surgical intervention; some experienced side effects, including hot flashes (34.7%) and mood changes (4.2%). Average uterine size from imaging prior to LA was 1286.3 g (range 135.1 g, 2819.0 g). Patients underwent hysterectomy (54.7%), myomectomy (43.2%), and radiofrequency ablation (2.1%); the majority of procedures were minimally invasive (83.2%). The average change in uterine weight in patients who underwent hysterectomy was 566.3 g (IQR 188.8 g, 872.3 g). Of patients undergoing hysterectomy, nine (17.3%) experienced continued growth despite LA, and four (7.7%) experienced minimal size reduction (<200 g). Of patients who underwent conservative procedures with outcome data (n = 35), approximately half (45.7%) experienced improvement with LA, 40.0% experienced no response or growth of fibroids, and 14.3% experienced a minimal improvement. Overall, 63.2% of patients experienced improvement in fibroid burden from LA prior to surgical intervention. CONCLUSIONS: Preoperative use of LA demonstrated a measurable reduction in fibroid burden in more than half of patients, supporting its role as an effective adjunct in surgical management of large uterine fibroids. Further research is needed to identify patient and fibroid factors related to LA efficacy and surgical outcomes.Figure 1