Hormonal support in women with Asherman syndrome does not lead to better outcomes: A randomized trial

• Published in: Reproductive medicine and biology 2023-01, Vol.22 (1), p.e12526-n/a
• Main Authors: Hanstede, Miriam M. F., Stralen, Karlijn J., Molkenboer, Jan F. M., Veersema, Sebastiaan, Emanuel, Mark Hans
• Format: Article
• Language: English
• Subjects: Adhesion; Amenorrhea; Analysis; Clinical trials; Endometrium; Estrogen; Estrogens; fertility; gynartresia; hysteroscopy; Intrauterine devices; IUD; Menstruation; Miscarriage; Original; Pregnancy; Pregnancy complications; Pregnant women; Regression analysis; Surgeons; Ultrasonic imaging
• ISSN: 1445-5781; 1447-0578
• DOI: 10.1002/rmb2.12526

Purpose The purpose of the study was to investigate if adjuvant hormones after successful adhesiolysis lead to a reduction in spontaneous recurrence of adhesions and influence reproductive outcomes. Methods A single‐blind randomized controlled trial comparing administration of oral estrogen (the usual care group) with not giving estrogen (no estrogen) in women after successful adhesiolysis for Asherman syndrome. Women were included between September 2013 and February 2017, with a follow‐up of 3 years to monitor recurrences and reproductive outcomes. Analyses were based on an intention to treat analyses. This study was registered under NL9655. Results A total of 114 women were included. At 1 year, virtually all patients (except 3) were either having a recurrence or were pregnant. Women who did not receive estrogen did not have more recurrences of adhesions in the first year prior to pregnancy (66.1% in the usual care group, 52.7% in the no‐estrogen group, p = 0.15). Of the women in usual care, 89.8% got pregnant within 3 years, and 67.8% got a living child; this was 83.6% and 60.0%, respectively, in the no‐estrogen group (p = 0.33 and p = 0.39, respectively). Conclusion Usual care does not lead to better outcomes as compared with not giving exogenous estrogen but is associated with side effects. The administration of estrogen after adhesiolysis does not influence the chance of SRA and the reproductive outcome of women treated for AS and is therefore questionable.