Is routine preoperative preparation necessary for hysteroscopic endometrial resection?

Objective To assess whether routine preoperative preparation of the endometrium with danazol or GnRH analogues is really necessary for transcervical resection of the endometrium (TCRE). Design A prospective open trial. Setting Specialized arrangements in a private minimal access gynaecological centre and a research institute, in Mumbai, India. Participants 665 women who presented with excessive menstrual bleeding. Interventions Random allocation into groups receiving either no preoperative preparation, or danazol or gonadotrophin‐releasing hormone (GnRH) analogues, or progesterones for preoperative preparation, followed by hysteroscopic resection of the endometrium. Main outcome measures These included assessment of relief of symptoms, failures and satisfaction rate. Total operating time, amount of fluid used and absorbed, as well as complications observed over a period of 7 years were also recorded. Results The results of 665 TCRE procedures evaluated over a period of almost 7 years suggest that outcomes were not influenced by preoperative endometrial preparation. Lack of endometrial preparation was not associated with any increase in the complication rate, in procedures carried out by an experienced hysteroscopist. Routine endometrial preparation is not necessary, and it substantially increases the overall cost of the procedure, which is an important consideration in developing countries. Preoperative endometrial preparation is necessary only occasionally, when large submucous (>3 cm) fibroids are to be resected, as it may reduce the operating time and complication rate significantly. Relief from excessive menstrual bleeding occurred in 88% of patients, of whom 39% had amenorrhoea. Repeat TCRE was necessary in only 3% of patients, and 3% finally underwent hysterectomy. Conclusions TCRE can be conveniently performed by an experienced hysteroscopist without routine endometrial preparation with danazol/GnRH analogues. Our study shows that the incidence of complications was low, with successful results in 88% of patients with excessive menstrual bleeding.