The Effect of Estrogen in the Prevention of Adhesion Reformation After Hysteroscopic Adhesiolysis

Background information Asherman syndrome, which occurs after trauma to the basalis layer of the endometrium generally after endometrial curettage, may manifest as hypomenorrhea, amenorrhea, dysmenorrhea, infertility or recurrent miscarriage.

At present, hysteroscopic adhesiolysis is the recommended standard diagnostic method and treatment for IUA. Recurrence of uterine cavity adhesion post-operatively is frequently reported, especially in severe IUA patients. A number of strategies have been proposed to prevent recurrence of adhesion reformation, including the use of post-operative estrogen. However, it is still not known if estrogen therapy is indeed necessary or effective. In a prospective randomized study which evaluated the efficacy of estrogen in preventing IUA following hysteroscopic septal resection, it was found that estrogen did not have any benefit in reducing adhesion formation. In another RCT study on women with Asherman syndrome, there did not appear to be any difference in the recurrence of IUA and pregnancy rate between those who did or did not receive adjuvant hormonal medication. On the other hand, large doses of estrogen may result in endometrium fibrosis and inhibited endometrium receptivity.

It seems that the role of postoperative estrogen therapy in the prevention of recurrence of IU adhesions is still controversial. In this prospective, randomized, controlled study, we wish to determine if estrogen therapy is of benefit in preventing adhesion reformation after IUA for Asherman syndrome. As the effect may be different for subjects with different degrees of IUA, we propose to stratify the subjects into those with mild and severe IUAs.

Objectives To investigate if estrogen therapy can prevent adhesion reformation after adhesiolysis.

Patients The patients will be recruited from the hysteroscopy Center of the Fuxing Hospital, Beijing, China. Before the surgery all patients with suspected Asherman syndrome will undergo preoperative evaluations, including a detailed history of the menstrual pattern, any previous intrauterine surgery, reproductive history, as well as trans-vaginal ultrasonography. The severity and extent of intrauterine adhesions will be scored according to a classification system recommended by the American Fertility Society (AFS) (1988 version). The inclusion criteria include [1] women aged 18-40 years; written consent obtained; and agreement to have second-look hysteroscopy. The exclusion criteria included:1 has received estrogen therapy within 3 month of enrolment. 2 suffers from leiomyoma, endometrial polyps, cancer, or polycystic ovarian syndrome (PCOS). 3.History of genital tuberculosis; and 4. contraindications for estrogen therapy.