Is endometrial pre-treatment of value in improving the outcome of transcervical resection of the endometrium?

The aim of this study was to determine whether or not the use of medical pr e-treatment of the endometrium improves the outcome of transcervical resect ion of the endometrium with regards to long-term operative outcome, histolo gical findings and patient satisfaction. A prospective randomized trial com paring three endometrial pre-treatment agents (danazol, medroxyprogesterone acetate or nafarelin) with no pre-treatment was conducted. The main outcom e measures were: (i) thickness of the endometrium and myometrium resected; (ii) histological stage of the endometrium at the time of operation; (iii) the presence or absence of menses and (iv) patient satisfaction 1 year post operatively. Of the three pre-treatments studied, danazol produced a lower median endometrial thickness than the control, showed the greatest ability to induce atrophy of the endometrial glands and stroma (not statistically s ignificant) and produced the highest rate of amenorrhoea (not different to the control). Danazol and nafarelin produced significantly lower median end ometrial thickness than no pre-treatment. There were, however, no significa nt differences in the rates of amenorrhoea in any of the pretreatment group s compared with that in the control group. No improvement in clinical outco me or patient satisfaction is conferred by the use of medical pre-treatment s if transcervical resection of the endometrium is performed in the prolife rative phase of the menstrual cycle.