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Does Adjuvant Long-Acting Gestagen Therapy Improve the Outcome of Hysteroscopic Endometrial Resection in Women of Low-Resource Settings With Heavy Menstrual Bleeding?
MedLine Citation:
PMID:  23403087     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To test for the hypothesis of the beneficial effect of long-acting gestagens as an adjuvant postoperative therapy on the outcome of hysteroscopic transcervical endometrial resection (TCRE) in women of low-resource settings and suffering from ovulatory heavy menstrual bleeding (menorrhagia). DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: Low-resource tertiary care university hospital. PATIENTS: Seventy-one premenopausal women with established ovulatory menorrhagia. INTERVENTION: After randomization, 37 patients were treated with TCRE plus gestagen and 34 patients with TCRE alone. MEASUREMENTS AND MAIN RESULTS: Variations in menstrual patterns and bleeding scores, as well as amenorrhea and repeat surgery rates with treatment, were determined 1 year after resection. In those who continued to menstruate at 6 months, treatment with TCRE plus gestagen was associated with a significant reduction in the number of days bleeding from 7.2 to 3.4 (p ≤ .0001), increased cycle length from 24 to 30 (p = .02), a 60% reduction in dysmenorrhea score from 62 to 25 (p ≤ .0001), and a 60% reduction in premenstrual syndrome score from 55 to 22 (p = .04). Amenorrhea rates at 12 months in the TCRE plus gestagen and TCRE alone groups were 40% versus 26% (p = .02), with combined amenorrhea and hypomenorrhea rates of 75% versus 64% (p = .02), respectively. At 12 months, repeat surgery rates were higher in the TCRE alone group (21% vs 3%, p < .05). CONCLUSION: In a low-resource setting, the adjuvant postoperative long-acting gestagen therapy has proven to be superior in inducing amenorrhea after hysteroscopic TCRE.
Authors:
Tarek Shokeir; Mouhamed Eid; El-Said Abdel-Hady
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-8
Journal Detail:
Title:  Journal of minimally invasive gynecology     Volume:  -     ISSN:  1553-4669     ISO Abbreviation:  J Minim Invasive Gynecol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101235322     Medline TA:  J Minim Invasive Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of OB/GYN, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt (all authors). Electronic address: tarekshokeir1@hotmail.com.
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