Clinical Efficacy Analysis Of Different Doses Of Estrogen In The Adjuvant Treatment Of Moderate Or Severe Intrauterine Adhesions After Hysteroscopy

Background and ObjectiveIntrauterine adhesions?IUA?,which refers to various factors that cause damage to the lining of the uterine cavity and/or the cervix,resulting in partial or total adhesion of the uterine cavity muscle wall and/or cervical canal^[1],also known as Asherman syndrome.The main symptoms of clinical symptoms are periodic abdominal pain,decreased menstrual flow and even amenorrhea,which leads to repeated abortion or infertility^[2-3],which seriously affects women's physical and mental health and reproductive health.With the development of endoscopic techniques,hysteroscopic resection of adhesion?TCRA?has become the preferred method for the treatment of IUA^[6],but the rate of re-adhesion is high after TCRA.Related studies have shown that the rate of postoperative re-adhesion of severe intrauterine adhesions is as high as 62.5%^[7-8].Therefore,prevention of re-adhesion after TCRA,improvement of menstrual situations,and improvement of pregnancy outcomes are the key to the treatment of IUA.At present,estrogen-based artificial cycle therapy has been widely used in the clinical practice of treatment of IUA,but the dose of estrogen after TCRA is controversial,which is no uniform standard.In this study,three different doses of estrogen were used in the adjuvant treatment of TCRA to explore the optimal supplemental dose of postoperative estrogen.Materials and Methods1 MaterialsBetween January 2016 and January 2018,156 patients?aged 21-39 years old?were enrolled in the First Affiliated Hospital of Zhengzhou University,who underwent hysteroscopic diagnosis of moderate to severe intrauterine adhesions and who underwent TCRA and completed follow-up.Their average age is?28.76�5.04?years old.According to the patient's admission time,according to the random number method,they were randomly divided into three groups:A,B,and C,with 52 cases in each group.2 Methods2.1 Medication methods:On the first day after surgery,the three groups were given continuous treatment with estrogen and progesterone,that is,continuous oral estradiol valerate?Bujiale?for 21 days,and 7 days after the addition of progesterone capsule?Anqitan?200 mg/d.Group A was given estradiol valerate?Bujiale?4 mg/d,group B was given estradiol valerate?Bujiale?6 mg/d,and group C was given estradiol valerate?Bujiale?8 mg/d.Three groups were treated on a periodic basis for3 months.2.2 Observation:All patients were followed up regularly every month for 3 months.The menstrual cramps and adverse drug reactions were recorded.The hysteroscopy was performed 2 months after surgery to understand the uterine cavity morphology,and the pregnancy was observed within 1 year after telephone follow-up.3 Statistic methodsStatistical analysis was performed using SPSS 17.0 statistical software.The measurement data were expressed as mean�standard deviation,using analysis of variance;the count data was expressed by frequency and rate,and the chi-square test was used?the Bonferroni method was used to compare the two groups among them?.The P<0.05 was considered statistically significant,and the test level was?=0.05.Results1 Uterine cavity recoveryCompared with patients with different degrees of IUA,the rate of uterine cavity recovery in patients with moderate IUA and severe IUA was 75.47%and 60.00%respectively,and the difference was statistically significant?P<0.05?.For patients with moderate IUA,the recovery rate of uterine cavity in group B and group C was higher than that in group A?P<0.05?.There was no significance difference in the rate of uterine cavity recovery between group B and group C?P>0.05?.For patients with severe IUA,there was no significant difference in the A,B,and C groups?P>0.05?.2 Menstrual improvementCompared with patients with different degrees of IUA,the menstrual improvement rate of patients with moderate IUA and severe IUA was 73.58%and56.00%respectively,and the difference was statistically significant?P<0.05?.For patients with moderate IUA,the menstrual improvement rate of group B and group C was higher than that of group A,the difference was statistically significant?P<0.05?.There was no significant difference in the menstrual improvement rate between group B and group C?P>0.05?.For patients with severe IUA,there was no significant difference in the A,B,and C groups?P>0.05?.3 Side effect of drugThere was no adverse reaction in group A;There were 2 cases of stomach discomfort occurred in group B;There were 4 cases of stomach discomfort,and 3cases of breast tenderness,and 2 cases of weight gain in group C.There was significant difference between group B and group C?P<0.05?.4 Pregnancy rateAfter 1 year of follow-up,there were 15 cases of pregnancy in group A,and 19cases of pregnancy in group B,and 22 cases of pregnancy in group C.There was no significant difference in 1-year pregnancy rate between the three groups?P>0.05?.Conclusions1.For moderate IUA,an appropriate increase in estrogen dosage can effectively restore uterine cavity morphology and improve menstrual conditions,which can improve the efficiency of treatment and prevent re-adhesion;however,the excessive increase in dosage has no significant improvement in clinical effects,but instead it may cause an increase in adverse drug reactions.It is suggested that the moderate dose of estrogen can improve the prognosis and improve the clinical efficacy after moderate IUA.2.For severe IUA,increased estrogen dosage,its clinical efficacy did not improve significantly.It is suggested that the application of high-dose estrogen after severe IUA may have limited stimulation of residual endometrium.