Hyaluronic Acid Gels Versus Estrogen Therapy as Treatments for Reducing Adhesions in Patients Undergoing Hysteroscopic Adhesiolysis

Abstract

<h3>Study Objective</h3> The purpose of this paper is to analyze studies on medication therapy (preoperative and postoperative estrogen) versus physical barrier application (hyaluronic acid-based gels) in reducing adhesions in patients undergoing hysteroscopic adhesiolysis. We discuss the success of these treatment methods in the context of their safety profiles and reduction of complications such as infertility. <h3>Design</h3> Articles from 2010 to 2020 that provided data specific to hysteroscopic adhesiolysis were compiled through a PubMed search with Boolean logic. <h3>Setting</h3> Dosing of estrogen therapy varied. The American Society for Reproductive Medicine's classification system for intrauterine adhesions (based on extent of involvement in the uterine cavity, menstrual pattern, and type of adhesion) were utilized by the majority of studies. <h3>Patients or Participants</h3> 728 patients were treated with hyaluronic acid gels and 475 patients with estrogen therapy. <h3>Interventions</h3> IUA recurrence rate and severity ratings, menstrual patterns, pregnancy rates, and adverse events from all studies were evaluated alongside aggregate findings with meta-analysis. <h3>Measurements and Main Results</h3> Returning to normal menstrual pattern was more commonly reported with estrogen therapy than with hyaluronic acid gel usage. No major adverse effects were reported for either treatment. Adhesion severity displayed a positive correlation with reduction in adhesion recurrence in the group treated with hyaluronic acid gels and among 5 patients with Asherman's Syndrome who received estrogen therapy as part of their management of a false passage following hysteroscopic adhesiolysis. Neither treatment yielded a significant effect on pregnancy rate. <h3>Conclusion</h3> While both treatments display a positive safety profile, randomized controlled trials with hyaluronic acid gels suggested more favorable outcomes in menstrual pattern and adhesion recurrence. Further research should aim to document all three factors measured in our study. We emphasize the need for data on gravidity and parity as well as concrete dosage amounts of estrogen over numerical ranges for a nuanced investigation of how these new treatments affect post-surgery pregnancy.