Statement of Retraction: 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.

Endometrial polyps are a common cause of abnormal uterine bleeding. In-office hysteroscopic management is frequently performed to treat this frequently encountered pathology. To evaluate the long-term outcome and patients' satisfaction with office hysteroscopic polypectomy in patients with symptomatic endometrial polyps. Retrospective longitudinal observational study of all hysteroscopic polypectomies performed at d'Igualada University Hospital (Barcelona, Spain) between May 2016 and December 2018. The medical records were reviewed, and a telephone interview was conducted with all the patients diagnosed with symptomatic endometrial polyps who underwent outpatient hysteroscopic polypectomy, with the purpose of evaluating the post-procedure symptomatology and satisfaction with the procedure. A total of 848 outpatient hysteroscopies were performed, 379 of which were polypectomies. Of those, 163 procedures were performed in symptomatic patients and were included in the final analysis. The most common symptom among premenopausal patients was abnormal uterine bleeding (84.85%) and in postmenopausal women, postmenopausal bleeding (95.3%). After the procedure, the symptoms resolved or decreased considerably in 66.7% of premenopausal and 93.7% of postmenopausal patients. Additionally, 87.1% of the patients were very satisfied with the procedure. Office hysteroscopic polypectomy is an effective treatment for endometrial polyps with high patient satisfaction reported following the procedure.

Polyps are a common diagnosis in women of different ages. They can cause a variety of symptoms from bleeding to infertility and can even be the progenitor for malignancies. This was a retrospective cohort study conducted in Isfahan. A total of 1004 patients were included in this study. After hysteroscopic polypectomy, patients had their information regarding the complications and recurrence recorded. Symptoms improved in 639 (63.8%). Recurrence of polyps was seen in 143 (14.2%) patients. A total of 170 had a successful pregnancy, with 110 of them spontaneous. Using scissors had lower recurrence compared to graspers. Eight cases had complications during the treatment, two of which were major. Hysteroscopic polypectomy is the treatment of choice for uterine polyps. We show hysteroscopic polypectomy to have a high success rate and a low complications rate, with polypectomies done using scissors to have lower risk of complications or recurrence compared to graspers.

Objectives: Endometrial preparation provides significant surgical benefits prior to hysteroscopic procedures. However, there is still no consensus on the optimal presurgical protocol. Although there is evidence on rapid preparation, there are currently no studies on rapid endometrial preparation using combined oral contraceptives initiated at a “random” time in the menstrual cycle. The aim of the present trial was to evaluate the use of oral drospirenone/estetrol in random start rapid preparation of endometrium before office hysteroscopic polypectomy. Design: In this multicenter, prospective, randomized controlled trial, 80 women scheduled for polypectomy were randomly assigned to intervention (n = 40) or control (n = 40) groups. Participants/Materials, Setting, Methods: The intervention group received oral drospirenone/estetrol (3 mg/14.2 mg/day) for 14 days, starting at any menstrual cycle point (random start). Controls underwent polypectomy on cycle days 8–11 without any prior pharmacological intervention. Results: Pre- and post-procedure, endometrial thickness was significantly lower in the drospirenone/estetrol group (p < 0.001), and patients showed more hypotrophic/atrophic endometrial patterns (p < 0.001). Operative time, distension medium usage, incomplete resections, and bleeding during polypectomy were significantly lower in the drospirenone/estetrol group (p < 0.001). Endometrial preparation quality, uterine cavity visualization, and procedure satisfaction were higher in the drospirenone/estetrol group (p < 0.001). Furthermore, patients in the drospirenone/estetrol group experienced less pain during (p < 0.001) and after the procedure (p < 0.001), requiring fewer analgesics (p < 0.001) and shorter post-procedure discharge time (p = 0.01) than controls. Limitations: Limited sample size; possible variability due to different hysteroscopists, caused by the multicenter nature of the study; hysteroscopists were unmasked to treatment allocation; absence of a cost-effectiveness analysis. Conclusions: Treatment with drospirenone/estetrol could provide rapid, satisfactory and low-cost endometrial preparation before office polypectomy, improving surgical performance and patient compliance.

Pregnancy rates following hysteroscopic polypectomy, myomectomy, and a normal cavity in infertile patients

The use of oral nomegestrol acetate/estradiol in rapid and random start preparation of endometrium before office hysteroscopic polypectomies: A multicenter, prospective, randomized controlled trial

The use of nomegestrol acetate in rapid preparation of endometrium before operative hysteroscopy in pre-menopausal women

Hysteroscopy is now the established “gold standard” for the assessment and treatment of intrauterine pathology such as fibroids, polyps, synechiae, septa and endometrial resection and/or destruction, and is regarded as a safe, acceptable and well-tolerated procedure [1–5]. In fertile women, hysteroscopic procedures are best performed when the endometrium is thin because the operating time is lessened and fluid absorption decreases, making surgery easier [6–9]. For these reasons, the days immediately after menstruation are the best period for hysteroscopy. Scheduling surgery during the early follicular phase is not always possible, so several drugs have been proposed to reduce endometrial thickness, intra-operative bleeding, surgical difficulties and duration of surgery [6, 10, 11]. Even if preoperative treatment with gonadotropinreleasing hormone analogues (GnRH-a) or danazol for 2 or 3 months has been recommended to remove large intramural sub-mucous myomas or perform endometrial resection [9], they are not as often used for procedure preparation especially in case of minor hysteroscopy. GnRH-a result in a state of temporary menopause and are expensive, while danazol induces unfavourable side effects including weight gain, growth of hair, acne and general malaise [12]. Several studies have reported that gestrinone also is capable of reducing uterine volume, menorrhagia and endometrial thickness [13–15]. A limiting factor existing among the previous treatments is the long time required to reduce the endometrium. Recently, to speed up endometrial preparation, other original treatments have been proposed as oral progestins and vaginal raloxifen [16], nomegestrol acetate [17] and oral contraceptives [18], and they obtained good results in terms of preparation of the endometrium, cost and acceptability. Shortening the preparation time before surgery may improve patient compliance and work organization [19]. The aim of this prospective, randomised study was to compare the effectiveness of nomegestrol acetate versus combined oral contraceptive treatments as short preoperative endometrial preparation before hysteroscopic surgery. L. Mereu (*) :G. Giunta :G. Carri : C. Prasciolu : E. D. Albis Florez : L. Mencaglia Division of Gynaecology, Centro Oncologico Fiorentino, Sesto Fiorentino, Italy e-mail: liliana.mereu@lacittadellasalute.it

Rapid endometrial preparation for hysteroscopic surgery with oral desogestrel plus vaginal raloxifene: a prospective, randomized pilot study

Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study.

Hysteroscopic management of endometrial polyps

Endometrial Preparation With Estradiol Plus Dienogest (Qlaira) for Office Hysteroscopic Polypectomy: Randomized Pilot Study

Objective: While consensus on the optimal endometrial preparation protocol for frozen-thawed embryo transfer (FET) is lacking, this is particularly true for patients with infertility and a history of endometrial polyps (EPs). In this study, we aimed to investigate whether a gonadotropin-releasing hormone agonist combined with hormone replacement therapy (GnRHa-HRT) could improve pregnancy outcomes in single euploid FET for patients with a history of EPs. Methods: In this retrospective cohort study, 395 women who underwent their first single euploid FET cycle were divided into groups according to endometrial preparation protocols as follows: natural cycle (NC) (n=220), hormone replacement therapy (HRT) (n=122), and GnRHa-HRT groups (n=53). Subsequently, the FET cycles in the three groups were subdivided according to maternal age. All patients underwent hysteroscopic polypectomy before FET, and their EPs were confirmed by pathology. Results: No statistically significant differences were observed in live birth rates among the three groups (58.64% vs. 58.20% vs. 56.60%, P=0.964). Furthermore, the rates of miscarriage, ectopic pregnancy, premature live birth, and pregnancy complications were comparable among the three groups (P &gt;0.05). After adjusting for potential confounding factors, no significant differences in pregnancy outcomes were reported between the groups (adjusted odds ratios [OR] and 95% credible intervals [CI] for live birth rate, HRT vs. NC: 1.119, 0.660–1.896, P=0.677; GnRHa-HRT vs. NC: 1.165, 0.610–2.226, P=0.643). Additionally, the pregnancy outcomes of the FET cycle were not influenced by the endometrial preparation protocols in the subgroups when stratified by maternal age (P &gt;0.05). Conclusion: GnRHa-HRT did not improve the pregnancy outcomes of the single euploid FET in patients with a history of EPs.