The Effect of Estrogen in the Prevention of Adhesion Reformation after Hysteroscopic Adhesiolysis: A Prospective Randomized Control Trial

Study Objective: To evaluate whether estrogen therapy can reduce adhesion reformation after hysteroscopic adhesiolysis. Design: A single-center, single blinded, randomized controlled trial. Setting: A tertiary University Hospital. Patients: A total of 207 patients with mild (American Fertility Society [AFS] score 1-6) and severe (AFS score 7-12) intrauterine adhesion who underwent hysteroscopic adhesiolysis. Interventions: Patients were randomized to a treatment group or a control group, stratified according to the preoperative AFS adhesion score. The treatment group received estrogen, and the control group did not. All patients had second-look hysteroscopy at 4 weeks and third-look hysteroscopy at 8 weeks after surgery. Measurements and Main Results: Primary outcome measures were adhesion reformation rate and AFS score at thirdlook hysteroscopy. Secondary outcome measures included adhesion reformation rate and AFS score at second-look hysteroscopy and menstrual pattern improvement rate at 3 months after operation. Among subjects with mild intrauterine adhesion, there was no significant difference between the treatment group and control group with regard to adhesion reformation rate at third-look hysteroscopy (10.6% vs 13.6%), AFS score (mean perpendicular to standard deviation) at third-look hysteroscopy (1.1 +/- 1.2 vs 1.3 +/- 1.2), and menstrual pattern improvement rate at 3-month follow-up (89.4% vs 86.4%). Similarly, among those with severe intrauterine adhesion, there was no significant difference between the treatment group and control group in adhesion reformation rate at third-look hysteroscopy (32.6% vs 26.7%), AFS score (mean +/- standard deviation) at third-look hysteroscopy (2.5 +/- 2.2 vs 2.7 +/- 2.1), and menstrual pattern improvement rate at 3-month follow-up (84.8% vs 73.3%). Conclusion: Postoperative estrogen therapy did not appear to reduce the incidence or severity of adhesion reformation, nor did it improve the menstrual pattern, regardless of whether the pre-existing intrauterine adhesion was mild or severe. (C) 2022 AAGL. All rights reserved.

Automated summary

The study aimed to evaluate whether estrogen therapy can reduce adhesion reformation after hysteroscopic adhesiolysis. The results showed that postoperative estrogen therapy did not reduce the incidence or severity of adhesion reformation, nor did it improve the menstrual pattern, regardless of the severity of the pre-existing intrauterine adhesion.