A prospective, randomized, controlled trial comparing two doses of oestrogen therapy after hysteroscopic adhesiolysis to prevent intrauterine adhesion recurrence

Abstract

The aim of this prospective, randomized, controlled trial was to evaluate the efficacy of different doses of oestrogen treatment (2 mg and 6 mg daily) after hysteroscopic adhesiolysis in patients with moderate to severe adhesion according to the American Fertility Society (AFS) classification of intrauterine adhesions. A total of 121 patients were included in the final analysis. Fifty-nine patients received 2 mg oestrogen daily (low-dose group), and 62 received 6 mg oestrogen daily (high-dose group) for three cycles after surgery. Second- and third-look outpatient hysteroscopy was performed 4 and 8 weeks after the initial surgery. There was no difference in the menstrual pattern and AFS scores before and after surgery between the two groups, and AFS scores at the second- and third-look hysteroscopy were found to be significantly lower than the scores before surgery in both groups (both P < 0.01). While this study did not address the fundamental question of whether oestrogen adjuvant therapy prevents the recurrence of intrauterine adhesions, the findings do not support the use of high-dose oestrogen therapy after hysteroscopic adhesiolysis.

<p>Asherman&rsquo;s syndrome: current perspectives on diagnosis and management</p>

“…No superior effect of the high dosage was demonstrated 69. When comparing 2 mg and 6 mg in a prospective, randomized trial, no benefit was demonstrated in the 6 mg arm 70…”

Controversy in the management of oestrogen therapy before hysteroscopic adhesiolysis: a systematic review and meta-analysis

“…No significant difference was reported between different doses ranging from 2 mg to 12 mg (Xiao et al, 2014;Guo et al, 2017;Guo et al, 2019;Liu L et al, 2019), but in the study by Liu AZ et al (2016), the use of a larger amount of oestradiol (9 mg daily) is significantly better than the group taking 3 mg daily. Chen et al (2010) reported that a larger amount of oestrogen may induce fibrosis of the endometrium.…”

A randomized controlled study on an integrated approach to prevent and treat re-adhesion after transcervical resection of moderate-to-severe intrauterine adhesions

“…However, it is difficult to completely seal the wound surfaces due to the possible risks of endometrial ischemic necrosis, abnormal bleeding, infection, contraceptive ring incarceration, and uterine perforation. The use of estrogen is the main method to promote endometrial regeneration and repair, but the efficacy of this method depends on whether there is enough residual endometrial tissues and on the dosage of estrogen used (17,18). Many scholars have committed to seek effective methods for preventing and treating recurrence of IUA postoperatively.…”