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Hysteroscopy is now the established “gold standard” for the assessment and treatment of intrauterine pathology such as fibroids, polyps, synechiae, septa and endometrial resection and/or destruction, and is regarded as a safe, acceptable and well-tolerated procedure [1–5]. In fertile women, hysteroscopic procedures are best performed when the endometrium is thin because the operating time is lessened and fluid absorption decreases, making surgery easier [6–9]. For these reasons, the days immediately after menstruation are the best period for hysteroscopy. Scheduling surgery during the early follicular phase is not always possible, so several drugs have been proposed to reduce endometrial thickness, intra-operative bleeding, surgical difficulties and duration of surgery [6, 10, 11]. Even if preoperative treatment with gonadotropinreleasing hormone analogues (GnRH-a) or danazol for 2 or 3 months has been recommended to remove large intramural sub-mucous myomas or perform endometrial resection [9], they are not as often used for procedure preparation especially in case of minor hysteroscopy. GnRH-a result in a state of temporary menopause and are expensive, while danazol induces unfavourable side effects including weight gain, growth of hair, acne and general malaise [12]. Several studies have reported that gestrinone also is capable of reducing uterine volume, menorrhagia and endometrial thickness [13–15]. A limiting factor existing among the previous treatments is the long time required to reduce the endometrium. Recently, to speed up endometrial preparation, other original treatments have been proposed as oral progestins and vaginal raloxifen [16], nomegestrol acetate [17] and oral contraceptives [18], and they obtained good results in terms of preparation of the endometrium, cost and acceptability. Shortening the preparation time before surgery may improve patient compliance and work organization [19]. The aim of this prospective, randomised study was to compare the effectiveness of nomegestrol acetate versus combined oral contraceptive treatments as short preoperative endometrial preparation before hysteroscopic surgery. L. Mereu (*) :G. Giunta :G. Carri : C. Prasciolu : E. D. Albis Florez : L. Mencaglia Division of Gynaecology, Centro Oncologico Fiorentino, Sesto Fiorentino, Italy e-mail: liliana.mereu@lacittadellasalute.it

gynecological surgery

Nomegestrol acetate versus combined oral contraceptive as rapid endometrial preparation for operative hysteroscopy: a prospective randomised pilot study