Preoperative promestriene for hysteroscopy: a randomized clinical trial

TL;DR

This study tested if promestriene before hysteroscopy reduces complications in postmenopausal women but found no significant difference compared to a placebo.

Contribution

The study provides new clinical evidence on the effectiveness of promestriene for cervical preparation in hysteroscopy.

Findings

Promestriene did not significantly reduce intraoperative complications compared to placebo.

Complications included difficult cervical dilation, cervical laceration, and vaginal laceration in both groups.

Abstract

Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy.

This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery.

There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration.

Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.

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