Hysteroscopic surgery is widely used for the treatment of patients sufferin
g from infertility and menorrhagia. Preoperative and postoperative treatmen
t plays an important role in this kind of surgery. The indications for horm
onal pre- and postoperative treatment are very different and depend on the
type of surgery and the condition of the patient. For a septum dissection,
preoperative treatment is not necessary. Postoperative estrogen therapy can
be helpful especially after dissection of a large septum. For intrauterine
adhesiolysis, preoperative treatment is without benefit. In cases of adhes
ions of grades 3 and 4, postoperative treatment entailing insertion of an I
UD and application of estrogens for about 3 months is recommended. A higher
amenorrhea rate after endometrium ablation can be reached by pretreatment
with a GnRH analogue or danazol. For resection methods, pretreatment is not
necessary in any case. The success rate of endometrium ablation (reduction
of blood loss) is not influenced by pretreatment. Pretreatment can be usef
ul in coagulation techniques in patients suffering from secondary anemia an
d in high-risk patient. In patients who need hormone replacement therapy af
ter endometrium ablation, gestagen application is necessary. For prevention
of bleedings, a continuous combined hormone replacement therapy should be
used and so a bleeding-free treatment is possible. The residual endometrium
will so be protected against hyperplasia. Another alternative postoperativ
e method after endometrial ablation is insertion of a levonorgestrel IUS. O
ur studies show advantages for protection of the endometrium, for contracep
tion and a high amenorrhea rate. Prior to a hysteroscopic myoma resection,
pretreatment with GnRH analogues is indicated for all myomas with a diamete
r of more than 3 cm and/or an intramural portion or for patients suffering
from secondary anemia. The aim of the pretreatment is not only to obtain a
thin endometrium but also to reduce the size and vascularization of the myo
mas. The failure rate in patients not treated with GnRH analogues is higher
especially in large intramural myomas. Pre- and postoperative hormonal tre
atment can be effective, especially in the treatment of patients suffering
from menorrhagia. The indications for hormonal pre- and postoperative treat
ment should be very strong. A hysteroscopic surgeon should be also have som
e experience in hormonal treatment.