***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND The efficacy and side-effect profile of ulipristal acetate as compared with those of leuprolide acetate for the treatment of symptomatic uterine fibroids before surgery are unclear . METHODS In this double-blind noninferiority trial , we r and omly assigned 307 patients with symptomatic fibroids and excessive uterine bleeding to receive 3 months of daily therapy with  oral ulipristal acetate  ( at a dose of either 5 mg or 10 mg ) or once-monthly intramuscular injections of leuprolide acetate ( at a dose of 3.75 mg ) . The primary outcome was the proportion of patients with controlled bleeding at week 13 , with a prespecified noninferiority margin of -20 % . RESULTS Uterine bleeding was controlled in 90 % of patients receiving 5 mg of ulipristal acetate , in 98 % of those receiving 10 mg of ulipristal acetate , and in 89 % of those receiving leuprolide acetate , for differences ( as compared with leuprolide acetate ) of 1.2 percentage points ( 95 % confidence interval [ CI ] , -9.3 to 11.8 ) for 5 mg of ulipristal acetate and 8.8 percentage points ( 95 % CI , 0.4 to 18.3 ) for 10 mg of ulipristal acetate .  Median times to amenorrhea were 7 days for patients receiving 5 mg of ulipristal acetate , 5 days for those receiving 10 mg of ulipristal acetate , and 21 days for those receiving leuprolide acetate .  Moderate-to-severe hot flashes were reported for 11 % of patients receiving 5 mg of ulipristal acetate , for 10 % of those receiving 10 mg of ulipristal acetate , and for 40 % of those receiving leuprolide acetate ( P<0.001 for each dose of ulipristal acetate vs. leuprolide acetate ) . CONCLUSIONS Both the 5-mg and 10-mg daily doses of ulipristal acetate were noninferior to once-monthly leuprolide acetate in controlling uterine bleeding and were significantly less likely to cause hot flashes . ( Funded by PregLem ; Clinical Trials.gov number , NCT00740831 . ) OBJECTIVE To investigate the effect of 2 medications ; Diphereline and Cabergoline , on uterine leiomyoma growth , and its histologic , sonographic , and intra-operative changes . METHODS In an effort to treat large uterine leiomyoma in symptomatic patients in the Gynecology Clinics of the Alzahra Teaching Hospital of Tabriz University of Medical Sciences , Tabriz , Iran , from September 2007 to November 2008 , 60 c and i date s r and omized to receive  Diphereline 3.75 mg , 4 times every 28 days ( group I ) , and Cabergoline 0.5 mg , once a week for 6 weeks ( group II ) , were included in this study . Clinical symptoms , feasibility of intra-operative dissection , intraoperative complications , sonographic , and pathologic characteristics of the tumor were evaluated . RESULTS Thirteen patients from group I , and 10 patients from group II underwent surgery . There was a significant difference between the groups in the rate of lymphocyte infiltration ( p=0.003 ) , but not in other pathologic features . In both groups , the mitotic index was between 0 - 10 . While there was no significant difference between the groups in the number ( p=0.30 ) , and volume of leiomyomas ( p=0.65 ) , however , changes in the uterine artery circulation was significant ( p=0.001 [ group I ] , p=0.026 [ group II ] ) . In addition , there was a significant difference between the groups for intra-operative hemorrhage and adhesion of leiomyomas to the uterine wall . CONCLUSION This study found that Cabergoline is as effective as Diphereline in the shrinkage of myomas , accompanied by improvement in the sonographic , clinical , and intra-operative outcomes without any adverse pathological changes , and could be a good medical regimen as an adjunct to surgical management A. J. M. AUDEBERT , P. MADENELAT * , D. Q U E R L E U ? , G. P O N T O N N I E R ~ , C . R A C I N E T ~ , R.R E N A U D ~ , J.-Y. GILLET * * , D. R A U D R A N T ? ~ , J. LANSAC:~ , J.-P. B R E T T E ~ Cnbitiet Medical . Bordeaus : * Hdpital Bichat , Paris ; ? Centre Hospitalier , Roubai.r ; 1 Hdpital de la Grave , Toulouse ; $ Centre Hospiialier Sud , Ecliirolles : Hfipital Central , Strasbourg ; * * Hi?pital Saint Roch , Nice ; ttH6pital de I'Hdtel Dieu , Lyon ; : $ Hdpital de Tours , Tours ; and # Hipito1 Monwti . Brest . OBJECTIVE To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive . DESIGN R and omized controlled trial . SETTING Departments of obstetrics and gynecology of the universities of Catanzaro , Rome , and Florence , Italy . PATIENT(S ) One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility . INTERVENTION(S ) Laparoscopic and minilaparotomic myomectomy . MAIN OUTCOME MEASURE(S ) Pregnancy , abortion , and live-birth rates . RESULT ( S ) Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy , live-birth , and abortion rates , whereas pregnancy and live-birth rates per cycle , and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group . Categorizing the patients according to surgical indication for myomectomy , cumulative pregnancy rate , pregnancy , and live-birth rates per cycle , and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients , whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility . CONCLUSION ( S ) Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility , whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas Summary . Twenty‐four women with symptomatic multiple uterine myomas were allocated r and omly to treatment with buserelin , 1200μg/day intranasally , for 3 months followed by myomectomy ( n = 8) or to immediate myomectomy ( n = 16 ) . Pre‐operative treatment with buserelin  reduced the mean uterine volume from 432 ( SD 165 ) to 242 ( SD 82 ) ml ( P < 0.01 ) but intra‐operative blood loss and postoperative morbidity were not significantly less in this group . Six months after operation , pelvic examination was normal in all the patients . However , ultrasonography with transvaginal probe demonstrated the presence of myomas of < 1.5 cm in five women ( 63 % ) treated pre‐operatively with the analogue and in two women ( 13 % ) who underwent immediate surgery ( P < 0.05 ) . Induction of a period of hypo‐oestrogenism before myomectomy seems to favour short‐term recurrence of uterine myomas , limiting the efficacy of surgery OBJECTIVE To ascertain whether adjuvant gonadotropin-releasing hormone ( GnRH ) agonist therapy decreases blood loss during abdominal myomectomy . DESIGN R and omized controlled trial . SETTING Academic reproductive surgery center . PATIENT(S ) One hundred premenopausal women requiring first-line conservative surgery for symptomatic intramural or subserous fibroids . INTERVENTION(S ) Eight weeks of treatment with depot triptorelin before myomectomy or immediate surgery . MAIN OUTCOME MEASURES Intraoperative blood loss , operating time , degree of difficulty of the procedure , and short-term rate of fibroid recurrence . RESULT ( S ) Mean ( + /-SD ) intraoperative blood loss was 265 + /- 181 mL in triptorelin recipients and 296 + /- 204 in patients who had immediate surgery ( mean difference , -31 mL [ 95 % CI , -108 to 46 mL ] ) . No significant differences were observed in blood loss according to uterine volume , number of fibroids removed , or total length of myometrial incisions . Most procedures in either group were of routine difficulty . On ultrasonography 6 months after myomectomy , four women in the GnRH agonist group and one in the immediate surgery group had tumor recurrence . CONCLUSION ( S ) Treatment with a GnRH agonist before abdominal myomectomy has no significant effect on intraoperative blood loss . Thus , systematic use of medical therapy before abdominal myomectomy does not seem to be justified OBJECTIVE To assess the usefulness of 3-month treatment with ulipristal acetate ( UPA ) before laparoscopic myomectomy of large uterine myomas . STUDY DESIGN This retrospective analysis of a prospect ively collected data base included women of reproductive age requiring laparoscopic myomectomy with the following characteristics : FIGO type 3 , 4 or 5 myomas ; largest diameter of the main myoma ≥10 cm ; number of myomas ≤3 ; largest diameters of the other myomas ≤5 cm ( second myoma ) and ≤3 cm ( third myoma ) . Patients either underwent direct surgery ( group S ) or were treated before surgery with UPA for 3 months ( group UPA ) . RESULTS The mean ( ±SD ) intraoperative blood loss was lower in group UPA ( 507.1±214.9ml ) than in group S ( 684.2±316.8 ; p=0.012 ) . The total operative time was lower in group UPA ( 137.6±26.8min ) than in group S ( 159.7±26.8min ; p<0.001 ) ; there was no significant difference in the suturing time between the two study groups ( p=0.076 ) . Hemoglobin drop was lower in group UPA ( 1.1±0.5g/dl ) than in group S ( 1.3±0.7g/dl ; p=0.034 ) . Six patients in group S and no patient in group UPA required postoperative blood transfusions ( p=0.031 ) . Complications were not different between the two groups ( p=0.726 ) . Moreover , preoperative treatment with UPA caused a significant increase in hemoglobin levels ( 11.9±1.6g/dl ) compared with baseline ( 9.1±1.1g/dl ; p<0.001 ) . CONCLUSION A 3-month treatment with UPA before laparoscopy for large uterine myomas decreases intraoperative blood loss , hemoglobin drop , postoperative blood transfusion and length of surgery Abstract The aim of this r and omised prospect i ve study was to investigate the impact of preoperative gonadotrophin-releasing hormone agonist ( GnRHa ) compared with a control group with myomectomy . A total of 36 women ( n = 36 , group 1 ) with fibroids were r and omised to receive either two monthly doses ( n = 18/36 , group 1a ) or three monthly doses of goserelin ( n = 18/36 , group 1b ) prior to myomectomy . The 32 women who received no treatment ( group 2 ) comprised the controls . All patients had similar demographic features . There were no significant differences among the three groups with respect to : ( 1 ) mean intraoperative blood loss ; ( 2 ) preoperative and postoperative blood transfusion or ( 3 ) length of hospital stay . The only advantage of administering GnRHa prior to myomectomy for symptomatic fibroids in our population was a higher haemoglobin level prior to surgery among the women who received three doses of the drug Objectives To evaluate the efficacy and safety of 2.5 mg and 5 mg mifepristone during 3 months for the treatment of uterine fibroids before surgery . Design Multicenter r and omized clinical trial . Locations Eusebio Hernández Hospital , Havana , Cuba and the Alemán Hospital , Managua , Nicaragua . Subjects Included in the study were 146 women with symptomatic uterine fibroids . Treatment Group I : half a tablet of 5 mg ( 2.5 mg ) mifepristone taken orally every 24 hours , and Group II : one tablet of 5 mg mifepristone taken orally every 24 hours over a period of 3 months in both groups . Two endometrial biopsies were performed . Variables to evaluate efficacy Increase in average hemoglobin , changes in fibroid and uterine volume , and symptomatic improvement . Results The average hemoglobin at the end 
    Output:
    
Conclusion Administration of GnRHa prior to laparotomic myomectomy reduces blood loss and might decrease uterine adhesion formation .