Optimizing Hemostasis in Hysteroscopic Myomectomy: A Randomized Clinical Trial of Vaginal Danazol Versus Diphereline in Women With Abnormal Uterine Bleeding

Objective: To compare the efficacy of vaginal danazol versus Triptorelin in controlling intra-operative bleeding and improving surgical visualization during hysteroscopic myomectomy in women with abnormal uterine bleeding due to submucous myomas. Design: Randomized controlled clinical trial. Materials and Methods: One hundred ninety reproductive-age women undergoing operative hysteroscopy were enrolled, and 30 were excluded. A total of 160 patients with submucous myomas were randomly assigned to receive either vaginal danazol (200 mg twice daily for 30 days preoperatively) or intramuscular triptorelin administered twice at a 28-day interval. Outcomes included severity of intra-operative bleeding, clarity of the surgical field, operative time, volume of distension media used, completion rate of surgery, and intra-operative complications. Statistical analysis compared categorical and continuous variables between groups, with significance set at p<0.05. Results: A total of 145 patients completed the study. No intra-operative bleeding occurred in 78.1% of the danazol group compared with 19.4% in the triptorelin group (p<0.001). Mild, moderate, and severe bleeding were significantly more frequent in the triptorelin group. A clear operative field was achieved in 98.6% of the danazol group versus 29.2% in the triptorelin group (p<0.001). Mean operative time was similar between groups (10.9 vs 10.6 minutes, p=0.79), as was distension media use (2.0 L in both groups, p=0.99). The completion rate was 100% in both groups, with no intra-operative complications reported. Conclusions: Both vaginal danazol and triptorelin were effective in reducing intra-operative bleeding during hysteroscopic myomectomy. However, vaginal danazol provided superior surgical visualization with a significantly clearer operative field.