Oral Desogestrel as Endometrial Preparation before Operative Hysteroscopy: A Systematic Review

Rapid and random-start endometrial preparation before outpatient hysteroscopic polypectomy in patients of perimenopausal age

OBJECTIVE

This study aimed to assess the efficacy of randomly started oral dienogest/ethinylestradiol (DNG/EE) for swift endometrial preparation prior to outpatient hysteroscopic polypectomy in perimenopausal women.

METHOD

A multicenter, prospective, randomized controlled trial was conducted in university hospitals. Eighty perimenopausal women scheduled for outpatient hysteroscopic polypectomy between January 2023 and March 2024 were randomly assigned to either intervention (n = 40) or control (n = 40) groups. Exclusion criteria included concomitant endometrial pathologies, recent therapy and adnexal diseases. The intervention group received oral DNG/EE 2 mg/0.03 mg/day started on any day of the menstrual cycle for 14 days. The control group underwent polypectomy between menstrual cycle days 8 and 11 without pharmacological treatment.

RESULTS

Pre-procedure (p < 0.001) and post-procedure (p < 0.001) endometrial thickness were significantly reduced in the intervention group, along with a higher incidence of hypotrophic/atrophic endometrial patterns (p < 0.001). Surgical parameters also differed significantly between groups.

CONCLUSION

DNG/EE treatment offers rapid, cost-effective endometrial preparation, enhancing surgical outcomes and patient satisfaction during outpatient polypectomy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06316206.

Effects of Pre_Operation Desogestrel Estradiol in Endometrial Preparation at Hysteroscopic Polypectomy

Background

Hysteroscopic surgery is a common gynecologic process in many conditions. Endometrial thinning is the main successful key for this process associated with many preoperative preparations. This study aimed to evaluate DE (Desogestrel-estradiol) to reduce endometrial thickness in comparison with the control group.

Materials and Methods

This Randomized clinical trial was done on the patients candidate for polypectomy that were randomly divided into two groups of intervention and control; the first group received DE OCP (oral contraceptive pill with 30 microgram Ethinyl estradiol + 150 micro gram Desogestrel) once daily from the 1st to 5th day of the menstrual cycle for 21 days and then in the first day of next menstruation cycle, the drug was used up to one day before hysteroscopy done in the 5th to 8th day of the cycle. The second group received no drugs. Hysteroscopy was done in the early follicular phase in both groups and all the subjects received one dosage of Misoprostol a night before surgery.

Results

There were no significant differences between the parity, polyp size, and BMI (Body Mass Index) in the two groups. The mean duration of surgery, mean endometrial thickness before hysteroscopy, the quality of endometrial tissue, and surgeon satisfaction were significantly difference between the two groups. However, the quality of the surgeon's vision in the intervention group was better than the control group but there was no significant difference between the two groups.

Conclusion

Pre-operation endometrial thinning by oral contraceptives such as DE could be an effective method and reduce the duration of surgery.

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, müllerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.