Comparing levonorgestrel intrauterine system with hysteroscopic niche resection in women with postmenstrual spotting related to a niche in the uterine cesarean scar: a randomized, open-label, controlled trial

Emerging data on diagnosis and management of uterine isthmoceles: a rapid review

“…Data extraction was performed on the 100 articles that met inclusion criteria. These included four systematic reviews [3 [12][13][14][15][16][17][18]; two randomized control trials [19 ]; 12 video articles [62][63][64][65][66][67][68][69][70][71][72][73], 10 case reports [74][75][76][77][78][79][80][81][82][83]; one case series [84]; and 21 conference abstracts [64,. Excluding the conference abstracts, 25 countries were represented as the country of correspondence of the first author of the remaining 79 publications.…”

“…For a patient who is symptomatic but does not desire immediate fertility, hormonal medications including oral contraceptive pills and the levonorgestrel (LNG) intrauterine device (IUD) have been evaluated and shown to be effective at decreasing symptoms [14,19 & ,24,44]. One of the rare randomized control trials published in the last 18 months on this topic, Zhang et al [19 ] compared the LNG IUD to hysteroscopic resection in 208 women and found that while at 6 months postoperatively the LNG IUD was not more effective than hysteroscopic resection, at 9 months and onwards, the LNG IUD was superior to hysteroscopic resection in reducing amount of spotting and pelvic pain. Similarly comparing LNG IUD to hysteroscopic resection, a retrospective study by Huang et al [24] identified that patients with increased local vascularization of their scar niche observed during hysteroscopy may benefit more from LNG IUD than resectoscopy, noting a significant reduction in intermenstrual bleeding days in the LNG IUD group at 6 months posttreatment compared to the hysteroscopic resection group.…”