Discussion
postoperative intrauterine adhesions, IUA
ADHESION, MISCARRIAGES, CAVITY
An increasing amount of evidence has proven that postoperative estrogen therapy for IUA patients can help repair the endometrium, improve menstrual volume, and prevent the occurrence of re-adhesion to a certain extent (In this study, we evaluated the efficacy of two estrogen administration routes in different aspects. Both groups gained menstruation improvement rates of 67%, which suggest that postoperative transdermal administration of estrogen could achieve a comparable and satisfactory outcome of the endometrium function recovery as the oral estrogen. As for the recovery of the morphology of the endometrial cavity, both groups gained a mean AFS score reduction greater than 2, resulting in a favorable outcome in preventing re-formation of adhesion. For patients with postoperative pregnancy intention, the pregnancy rates after the procedures were 40.5% and 28% in the transdermal group and oral group, respectively. Although no statistically significant difference was observed between the two groups, patients in the transdermal group tended to have a higher pregnancy rate.In our study, both oral and transdermal estrogen supplementation achieved, to some extent, elevated serum E2 level, endometrium growth, prevention of IUA re-formation and improved menstruation. However, the pregnancy outcome at 1-year follow-up seemed not so optimistic and the menstruation recovery did not correlate with the pregnancy rate. It has been reported that pregnancy after TCRA is also related to endometrial metabolism and angiogenesis, and even high level of serum E2 combined with anti-adhesion measures is hard to reverse the altered biochemical or vascular environment of the endometrium (The dosage of estrogen administration for IUA is heterogeneous in the published literatures, ranging from 2mg to 8mg (Certain limitations must be considered when interpreting study findings. First, we missed the postoperative live birth outcome. Second, the number of patients with second-look hysteroscopy was small, and the overall sample size was relatively small as well. Lastly, the optimal dose of estrogen administration has not yet been determined. Given the prevalence of postoperative intrauterine adhesions, this is an area in need of well-designed trials to address questions regarding the optimal dosage of postoperative estrogen administration for IUA. Additionally, as the subsequent pregnancy after IUA treatment is at risk of miscarriages, our next step would be to investigate whether estrogen use improves long-term pregnancy outcomes, such as live birth rates.