Efficacy of estrogen therapy in patients with intrauterine adhesions: systematic review.
Hysteroscopic adhesiolysis has become the preferred option for management of intrauterine adhesions (IUA). Use of estrogen as perioperative adjuvant therapy has been suggested for preventing recurrent adhesions. The primary objective of this article was to review the literature for evidence of the efficacy of estrogen therapy in the management of IUA. All eligible studies were identified using computerized databases (PubMed, Scopus. and Web of Science) from their earliest publication date to July 2013. Additional relevant articles were identified from citations in these publications. Twenty-six studies were identified that reported use of hormone therapy as ancillary treatment after adhesiolysis. Of these studies, 19 used at least one of the following methods: intrauterine device, Foley catheter, hyaluronic acid gel, or amnion graft, in addition to hormone therapy as ancillary treatment. In 7 studies, hormone therapy was used as a single ancillary treatment. In 2 studies, no adjunctive therapy was used after adhesiolysis. Meta-analysis could not be performed because of the differences in treatment methods in these articles. There was a wide range of reported menstrual and fertility outcomes. Better menstrual and fertility outcomes were associated with use of estrogen in combination with other methods of ancillary treatment. At present, hormone therapy, in particular estrogen therapy, is beneficial in patients with IUA, regardless of stage of adhesions. However, estrogen therapy needs to be combined with ancillary treatment to obtain maximal outcomes, in particular in patients with moderate to severe IUA.
Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
Jolinda
J
Johary
Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
Min
M
Xue
Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
Xiaogang
X
Zhu
Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha City, Hunan Province, China. Electronic address: dabaoxu@yahoo.com.
Dabao
D
Xu
The Systematic Review Unit, Collaborative Research (CORE) Group, Sydney, Australia.
Prasad Palani
PP
Velu
D003131:Combined Modality Therapy; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007434:Intrauterine Devices; D000267:Tissue Adhesions / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
D004967:Estrogens
Endometrium; Estrogen therapy; Hysteroscopy; Intrauterine adhesions; Repeat adhesions