Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
In your section on fibroids, you state the following:
"Gonadotrophin releasing hormone analogues should be used before
surgery to shrink the fibroid, to make the surgery less vascular, and
often to allow improvement in haemoglobin concentration."
This statement seems to be all encompassing and contradictory with
the approved uses of GnRH (at least in the U.S.). Is it truly the
recommended intent that GnRH should ALWAYS be used for ALL sizes of
fibroids prior to surgery? On what basis of controlled research is this
recommendation made?
Research into the use of GnRH for fibroids and whether or not it
truly makes the surgery less vascular is not conclusive -- and the
bibliographic citations which would support this recommendation seem to be
missing from your paper. A balanced discussion of this topic would have
clearly shown the swirling controversy surrounding the preoperative use of
GnRH for fibroids. It would have, perhaps, also pointed out the potential
for reducing the size of some fibroids to the point of them being missed
entirely on surgery. Hardly a positive outcome for a woman looking to
conceive and undergoing myomectomy with the belief that all of her
fibroids are going to be removed and thereby clear the way for possible
conception.
What is this love for GnRH that so many gynecologists have? Where
did it come from? Where is the research with its use in fibroids that
supports carte blanche recommendations, such as the one made in this
paper?
GnRH
In your section on fibroids, you state the following:
"Gonadotrophin releasing hormone analogues should be used before
surgery to shrink the fibroid, to make the surgery less vascular, and
often to allow improvement in haemoglobin concentration."
This statement seems to be all encompassing and contradictory with
the approved uses of GnRH (at least in the U.S.). Is it truly the
recommended intent that GnRH should ALWAYS be used for ALL sizes of
fibroids prior to surgery? On what basis of controlled research is this
recommendation made?
Research into the use of GnRH for fibroids and whether or not it
truly makes the surgery less vascular is not conclusive -- and the
bibliographic citations which would support this recommendation seem to be
missing from your paper. A balanced discussion of this topic would have
clearly shown the swirling controversy surrounding the preoperative use of
GnRH for fibroids. It would have, perhaps, also pointed out the potential
for reducing the size of some fibroids to the point of them being missed
entirely on surgery. Hardly a positive outcome for a woman looking to
conceive and undergoing myomectomy with the belief that all of her
fibroids are going to be removed and thereby clear the way for possible
conception.
What is this love for GnRH that so many gynecologists have? Where
did it come from? Where is the research with its use in fibroids that
supports carte blanche recommendations, such as the one made in this
paper?
Competing interests:
None declared
Competing interests: No competing interests