Hysteroscopic laser ablation of symptomatic uterine fibroids: insights from a prospective study.

OBJECTIVE: This study aimed to evaluate the feasibility and efficacy of in-office hysteroscopic ablation of submucous uterine fibroids using a diode laser. METHOD: A pilot study was conducted between January 2018 and January 2019 in a tertiary care university hospital. Patients with at least one symptomatic, class 0-2 FIGO classification, uterine fibroid ≤7 cm in size were eligible for inclusion. Evaluation of the changes in fibroid size and vascularity was performed using three-dimensional Doppler ultrasonography. Vaporization of the fibroid core was conducted using a 980-1470 nm wavelength diode laser inserted through the hysteroscope's working channel. The primary outcome was evaluation of the fibroid volume before and at 2 months after the procedure. RESULTS: Twenty women were enrolled in the study. At 2-month follow-up, the volume of the fibroids was significantly reduced (51.6 ± 22.5 vs. 33.4 ± 17.1 mm3; p < 0.001). A major reduction of three-dimensional sonographic color Doppler vascularity (observed by the same operator and confirmed by four blind reviewers) was also achieved in 12/20 patients (60%; p = 0.03) while a reported symptom of heavy menstrual bleeding decreased from 18/20 (90%) to 2/18 (10%; p < 0.01). CONCLUSION: Hysteroscopic laser ablation represents a feasible and effective alternative for treating women with symptomatic submucous fibroids in the office setting. Further studies with larger sample size and longer follow-up periods are needed to validate this promising technique.Key messageThis pilot study shows that in-office hysteroscopic laser ablation (HLA) could be a feasible alternative to treat symptomatic submucous uterine fibroids by coagulating their core, reducing their size and vascularization.

Endometrial biopsy under direct hysteroscopic visualisation versus blind endometrial sampling for the diagnosis of endometrial hyperplasia and cancer: Systematic review and meta-analysis.

Background: Endometrial cancer is the most common gynaecological neoplasia in western countries. Diagnosis of endometrial cancer requires an endometrial biopsy. A good quality endometrial biopsy allows not only the identification of the pathology, but also preoperative histologic subtype classification. Endometrial biopsy can be performed under direct hysteroscopic visualisation, but also using blind sampling techniques. Objectives: To compare endometrial biopsy performed under direct hysteroscopic visualisation versus blind sampling for the diagnosis of endometrial hyperplasia and cancer. Materials and Methods: Systematic review and meta-analysis. Electronic databases were searched from their inception until March 2022.We included all studies comparing endometrial biopsy performed under direct hysteroscopic visualisation versus blind endometrial sampling. Main outcome measures: Sample adequacy, failure rate to detect endometrial cancer or endometrial hyperplasia, and rate of detection of endometrial cancer. The summary measures were reported as relative risk (RR) with 95% of confidence interval (CI). Results: Four studies with a total of 1,295 patients were included. Endometrial biopsy under direct hysteroscopic visualisation was associated with a significantly higher rate of sample adequacy (RR 1.13, 95% CI 1.10 to 1.17), and significantly lower risk of failure to detect endometrial cancer or endometrial hyperplasia (RR 0.16, 95% CI 0.03 to 0.92) compared to blind endometrial sampling. However, there was no significant difference between endometrial biopsies taken under direct hysteroscopic visualisation or blindly, with or without a preceding diagnostic hysteroscopy, in the rate of detection of endometrial cancer (RR 0.18, 95% CI 0.03 to 1.06). Conclusion: Hysteroscopic endometrial biopsy under direct visualisation is associated with significantly higher rate of sample adequacy and is comparable to blind endometrial sampling for the diagnosis of endometrial cancer and precancer. What is new?: Hysteroscopic endometrial biopsy under direct visualisation would be expected to reduce diagnostic failure for endometrial cancer compared to blind endometrial sampling.

DIU de levonorgestrel como método anticonceptivo: aceptación, continuidad y asesoramiento en España / The levonorgestrel intrauterine device as a contraceptive method: acceptance, continuation rates and counselling in Spain

Objetivo: Valorar la aceptación y la continuidad del uso como anticonceptivo del DIU de levonorgestrel (DIU-LNG, Mirena®) en mujeres españolas que optan por anticoncepción intrauterina, prestando especial atención al asesoramiento. Métodos: Se informa sobre las opciones disponibles, entre ellas el DIU-LNG. Se valoran variables relevantes para la elección del método, incluido el asesoramiento. Seguimiento durante 1 año del grupo que opta por Mirena®. Resultados: De las 944 mujeres incluidas, 542 optaron por el DIU-LNG. Se constató un descenso progresivo del sangrado, en días y medidas higiénicas (de 21,00 ± 14,22, medidas en la visita de inserción, a 3,59 ± 4,86 al año). Presentaron efectos secundarios el 21,75, el 16,03 y el 13,67% de las mujeres en las sucesivas visitas (2, 3 y 4), respectivamente. En general, Mirena® fue bien tolerado, sin efectos secundarios graves. No se objetivaron gestaciones ni complicaciones graves. Al año, el grado de satisfacción fue bueno-muy bueno en el 93% de usuarias y la continuidad fue superior al 90%. Conclusiones: El DIU-LNG es un método adecuado para las mujeres españolas interesadas en anticoncepción intrauterina y especialmente con sangrado menstrual más intenso, y muestra alto grado de satisfacción y tasa de continuidad. Los efectos secundarios que aparecen son leves, generalmente bien tolerados y pueden persistir durante el primer año. Un cuidado asesoramiento permite una elevada aceptación y tasa de continuidad de este método

Objective: To evaluate acceptability and continuity of use of the levonorgestrel intrauterine device (LNG-IUD, Mirena®) as a contraceptive method among Spanish women choosing intrauterine contraception, with special attention paid to counselling. Methods: Women requesting contraception were informed of the available choices, including the LNG-IUD. Variables involved in the choice of method, including counselling, were evaluated. Women who chose Mirena® were followed-up for 1 year. Results: Of the 944 women included in this study, 542 chose the LNG-IUD. We observed a significant and progressive decrease in bleeding and in the number of bleeding days and sanitary pads used (from 21.00 + 14.22 sanitary pads at insertion to 3.59 ± 4.86 after 1 year). Adverse effects were reported by 21.75%, 16.03% and 13.67% of women at visits 2, 3 and 4 respectively. In general, Mirena® was well tolerated, producing no major adverse effects. No pregnancies or major complications were observed. Alter 1 year of use, satisfaction was good-very good in 93% of users and the continuation rate was over 90%. Conclusions: The LNG-IUD is a suitable contraceptive method for Spanish women interested in intrauterine contraception, especially those with heavy menstrual bleeding. Satisfaction and continuation rates are high. Adverse effects are minor, generally well tolerated, and can last for the first year. Careful counselling produces high acceptability and continuation rates with this method