Leiomyomas are benign tumors derived from uterine smooth muscle cells. Epidemiologically, they are the most common tumors affecting the female genital system worldwide. From a clinical perspective, these tumors can elicit bothersome symptoms in up to one-third of patients. Instances of such symptoms encompass pelvic discomfort, heavy menstrual bleeding, constipation, and urinary frequency. Potential serious repercussions of leiomyomas comprise iron deficiency anemia, obstetric aftermaths, and infertility [1].

For symptomatic leiomyoma patients who do not attain success with expectant and medical management, surgical intervention becomes the first-line therapeutic option. These surgical interventions may largely entail performance of hysterectomy or myomectomy. In particular, myomectomy is the ideal surgical choice for patients who desire future childbearing [1,2].

Hemorrhage-related complications during myomectomy are common [3], owing to the enriched vascularity of leiomyomas [4]. Potential consequences of hemorrhage comprise intraoperative bleeding [3,[5], [6], [7]], which may be severe enough to necessitate blood transfusion [8]. Other possible repercussions of hemorrhage-related complications during myomectomy include deranged hemostasis, circulatory shock, and demise. Hence, interventions to lessen bleeding and associated complications during myomectomy are imperatively vital to decrease morbidity and mortality.

Several pharmacologic agents have been experimented in literature to decrease blood loss and associated morbidities during myomectomy. One example is vasopressin—a vasoconstrictive agent that can decrease blood loss [9]. It has been broadly employed in diverse gynecologic operations to mitigate the magnitude of intraoperative blood loss [9]. Several randomized controlled trials (RCTs) and nonrandomized controlled trials (NCTs) have investigated the efficacy and safety of perioperative vasopressin during myomectomy [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. Nonetheless, the evidence on the topic remains inconclusive, owing to the small number of sample sizes, conflicting results, and most importantly lack of a published related systematic investigation to comprehensively summarize the body of existing literature.

Therefore, this research aimed to collate evidence from controlled trials on the efficacy and safety of perioperative vasopressin versus passive control (placebo/no treatment) during myomectomy. Such research is important to establish concrete evidence that can prudently inform clinical decisions.