Desogestrel versus danazol as preoperative treatment for hysteroscopic surgery: preliminary data

Introduction Preoperative pharmacologic treatment of endometrial mucosa is recommended for hysteroscopic surgery, in order to reduce endometrial thickness, intraoperative bleeding, difficulties and duration of the procedure. Among the several drug that can be used for these purposes, both desogestrel and danazol seem to share a suppressive effect on local angiogenic and growth factor involved in endometrial and subendometrial proliferation, which might result in the reduction of cyclic regeneration of mucosa and consequent endometrial hypotrophy/atrophy. The aim of this study was to compare desogestrel and danazol as preoperative endometrial preparation for hysteroscopic surgery. Methods We enrolled 100 patients, in reproductive age, with endouterine pathologies (40 cases of endometrial polyp, 18 of uterine septum, 10 of myoma, 7 of fibromyoma, 8 of isthmocele, 7 of Asherman's syndrome), identified by office hysteroscopy during endometrial proliferative phase. Pre-treatment and post-treatment characterization of endometrium was performed by hysteroscopic visual observation and histologic confirmation. Preoperative endometrial characterization was defined as: “normal”, “normal with small hyperplastic area” or “hyperplastic”, according to Baggish’s criteria. The patients were randomly assigned to two groups: 50 were treated with 75 μg of desogestrel/die, 50 with 100 mg of danazol/die, both orally for 5 weeks, starting on day 1 of menstruation. Postoperative endometrial characterization was defined as: “normotrophic-nonresponder”, “hypotrophic with tickened areas” or “atrophic”. Intraoperative data (cervical dilatation time, operative time, infusion volume, severity of bleeding) and drugs’ side effects were recorded. For the comparison between the two groups, a P value <0,05 was considered statistically significant. Results No significant differences were found between the two groups in terms of age, parity, body mass index, incidence of endouterine pathology, endometrial pattern before treatment. Post treatment comparison of endometrial patterns (Tab. I) showed a statistically significant more marked effect of desogestrel, respect to danazol, in atrophying endometrium (“normotrophic non-responders” Vs “hypotrophic” - “atrophic”, p=0.031). Intraoperative data showed no significant differences between the two groups for cervical dilatation time (p=0.160), while in the desogestrel group we found a statistically significant reduction of operative time (p=0.020), infusion volume (p=0.012), severity of bleeding (p=0.004). Moreover, desogestrel, respect to danazol, caused less side effects (p=0.031). Conclusions Both treatments are effective to prepare endometrium for hysteroscopic surgery. However, desogestrel, respect to danazol, showed most marked effect in inducing endometrial atrophy and allowed a reduction of operative time, intraoperative bleeding and infusion volume. Furthermore, desogestrel caused less side effects during treatment.