A Comparison Of The Efficacy Between Two Estrogen Therapies In Intrauterine Adhesion Following Hysteroscopic Adhesiolysis

Objective:The purpose of this study is to compare the efficacy of two estrogen therapies following hysteroscopic adhesiolysis in patient with moderate intrauterine adhesions.Methods:We carried out a prospective randomized controlled study. A total number of81patients with history of menstrual disturbance, infertility or recurrent pregnancy loss who undergo diagnostic hysteroscopy and diagnosed with moderate intrauterine adhesions were enrolled in the study. After hysteroscopic adhesiolysis, patients were divided randomized to two different groups. First Group (control group) will be assigned to application of21days of oral estradiol valerate (3mg, bid) plus progesterone for the last6days (200mg, QN) therapy cyclically for4cycles. Second Group will be assigned to application of56days of continuous estradiol valerate (3mg, bid) plus progesterone (200mg, QN) therapy for the last6days, then continued with two cycles of estrogen therapy21days of oral estradiol valerate (3mg, bid) plus progesterone for the last6days (200mg, QN). A second look hysteroscopy was performed after completed hormonal therapy. The menstrual pattern, recurrence of adhesions, endometrium glands density, endometrium thickness by ultrasound, the time interval to conceive, and the reproductive outcome (pregnancy) were recorded.Results:1. Twelve cases excluded from final analysis. Eventually, a total of69cases were eligible in this study (38in control group,31in experimental group).2. At Second-look hysteroscopy:(1) At follow-up, there was a significance improvement to achieve normal menstrual duration in the group2when compared with patients in the group1(P=0.04).(2) Post-operatively, when both groups were compared, the menstrual duration of the patients in group2was markedly longer than those of the group1(4.20±1.19days as compared to4.94±1.16days, P=0.03).(3) Although the comparison of the reduction of adhesions score between group1and2did not show significant difference, patients in group2appeared to have lower mean adhesions scores in comparison with those in group1(0.87±1.66vs1.23±1.99, P>0.05).(4) A satisfactory anatomical result (completed elimination of all synechia) was obtained at second-look hysteroscopy in61patients (33out of38patients in group1compared with28out of31patients in group2)(89.5%vs90.3%; P>0.05). Although there was no significant difference, the need for repeated treatment was slightly lower in the patients of group2which repeated treatments were performed only in9.6%(3cases) as compared with13.2%(5cases) in the group1(P>0.05).(5) When compared, group1and group2showed no significant difference in the improvement of endometrial glands density and endometrial thickness post-operatively (P>0.05).3. Reproductive outcome:(1) There was no difference in the pregnancy rate in two groups. The mean duration of follow-up time was7.18±2.23months. The pregnancy rates after treatment were12/35(34.3%) and8/29(27.6%) in groups1and2, respectively (P>0.05).(2) There was no significant difference in mean time interval from the time of last surgery to the time of conception in group1(8.25±2.01months) and group2(8.37±2.44months)(P>0.05).(3) Although there was no significant difference, the obstetric complications (such as pregnancy losses, missed abortion, ectopic pregnancy,) were recorded higher in the group1(6/12,50%) as compared with group2(2/8,25%).Conclusions:Preliminary study indicated that continuous estrogen therapy following hysteroscopic adhesiolysis is not better than cyclic estrogen therapy in patient with moderate intrauterine adhesions.