Effectiveness of estrogen in the prevention of intrauterine adhesions after hysteroscopic septal resection: A prospective, randomized study

Roy, Kallol Kumar; Negi, Neha; Subbaiah, Murali; Kumar, Sunesh; Sharma, Jai Bhagwan; Singh, Neeta

doi:10.1111/jog.12297

Cited by 46 publications

(27 citation statements)

References 11 publications

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“…We identified 8 studies evaluating the role of hormonal therapy in preventing IUA [22,23,26,27,30,31,38,39]. Seven studies [22,23,26,27,30,31,38] have already been analyzed in the other ''Results'' sub-sessions.…”

Section: Post-operative Hormonal Therapymentioning

confidence: 98%

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Sardo

Calagna

Scognamiglio

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

121

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Section: Post-operative Hormonal Therapymentioning

confidence: 98%

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Sardo

Calagna

Scognamiglio

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

121

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“…114 Estrogen therapy alone has not been found to consistently prevent intrauterine adhesion formation or to improve reproductive outcomes; in a number of studies better fertility outcomes were associated with use of estrogen in combination with other prophylactic methods. 115,116 A systematic review of 5 trials concluded that the use of an antiadhesion barrier gel is associated with a decreased incidence of de novo intrauterine adhesions; however, this did not translate to an increase in live birth rate. 117 Another study comparing reproductive outcomes after operative hysteroscopy suggested no difference in the use of absorbable barriers including sodium hyaluronate and carboxymethylcellulose compared with a removable physical barrier (pediatric Foley), however, patients who underwent surgical hysteroscopy without adhesion prophylaxis had a reduced chance of pregnancy.…”

Section: Risk Reductionmentioning

confidence: 99%

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Munro

Christianson

2015

Clinical Obstetrics &Amp; Gynecology

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Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.

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“…Estrogen has been widely used in the prevention of IUA following operative hysteroscopy. Roy et al (26) reported that estrogen treatment reduced the incidence rate of IUA from 6.9 to 0%. In the present study, estrogen treatment significantly prevented the IUA-mediated increase in the serum levels of TGF-β1, EGF and PDGF-BB, indicating that estrogen may inhibit the development of IUA.…”

Section: Discussionmentioning

confidence: 99%

Effects of endometrial stem cell transplantation combined with estrogen in the repair of endometrial injury

et al. 2018

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Abstract. The present study investigated the effects of endometrial stem cell (EnSCs) transplantation combined with estrogen in the repair of endometrial injury. A total of 30 patients with intrauterine adhesions (IUA) and 30 healthy individuals were selected. Expression of epidermal growth factor (EGF) and platelet-derived growth factor (PDGF)-BB in endometrial tissue was assessed. Additionally, expression levels of epithelial membrane antigen (EMA), cytokeratin (CK), integrin α-6 (CD49f), Thy-1 membrane glycoprotein (THY-1), collagen type 1 (Col I), fibroblast (5B5) and vimentin in EnSCs were detected using western blot analysis and reverse transcription-quantitative polymerase chain reaction. A rat model of IUA was established and female rats were divided into the control, model, EnSCs, estrogen and estrogen plus EnSCs (E+EnSCs) groups. Blood was extracted at 1 and 5 weeks post-treatment, and serum levels of transforming growth factor (TGF)-β1, EGF, 17 β-estradiol (E2) and PDGF-BB were measured using ELISA. Hematoxylin and eosin staining was performed to observe the pathological changes of endometrial tissue in rats. Western blot analysis was used to detect the expression of estrogen receptor (ESR1) and matrix metalloproteinase (MMP)-9 in the endometrium. The results revealed that patients with IUA exhibited increased expression levels of EGF and PDGF-BB compared with those in control group. Additionally, EnSCs exhibited significantly increased expression levels of EMA, CD49f, CK, Col I, THY-1, 5B5 and vimentin compared with the remaining groups. An increased number of newly formed glands was observed in the E+EnSCs group compared with that in the EnSCs group.Increased levels of E2, but decreased levels of TGF-β1, EGF, PDGF-BB, ESR1 and MMP-9 were detected in EnSCs and estrogen groups compared with those in E+EnSCs group. These results suggest that EnSCs transplantation combined with estrogen could improve endometrial abnormalities. IntroductionIntrauterine adhesions (IUA) refer to the endometrial fibrosis caused by endometrial injury in operative hysteroscopy (1). Endometrial injuries may lead to recurrent miscarriages, infertility, amenorrhea, abnormal placentation, dysmenorrhea and abnormal uterine bleeding, thus being detrimental to the health of affected women (2). Expression levels of transforming growth factor (TGF)-β1, epidermal growth factor (EGF), basic fibroblast growth factor and platelet-derived growth factor (PDGF)-BB were found to be significantly increased in exudates in patients with IUA following surgery (3,4), which in turn promoted the growth of fibroblasts and the formation of adhesions. Despite advances in intraoperative techniques, including minimizing trauma of the healthy myometrium and endometrium, and reducing the usage of electrosurgery (5), the incidence of IUA caused by surgery remains high. Therefore, the development of novel approaches to inhibit the formation of post-surgical IUA is required.A variety of novel therapies for IUA have been developed. Estrogen is the most importa...

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Effectiveness of estrogen in the prevention of intrauterine adhesions after hysteroscopic septal resection: A prospective, randomized study

Abstract: Estrogen treatment was not found to prevent intrauterine adhesions or improve reproductive outcome after hysteroscopic septal resection.

Cited by 46 publications

References 11 publications

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review

Complications of Hysteroscopic and Uterine Resectoscopic Surgery

Effects of endometrial stem cell transplantation combined with estrogen in the repair of endometrial injury

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