Endometrial preparation with desogestrel before Essure hysteroscopic sterilization: preliminary study.

STUDY OBJECTIVE

To assess the effect of desogestrel on endometrial preparation for transcervical sterilization using the Essure device.

DESIGN

Prospective nonrandomized clinical study (Canadian Task Force classification II-3).

SETTING

Acute-care university-affiliated hospital in Barcelona, Spain.

PATIENTS

Women undergoing sterilization using the Essure device between January 2010 and January 2011.

INTERVENTIONS

Participants were offered desogestrel, 75 μg/d, for 6 weeks before the procedure. Sixteen who accepted were included in the desogestrel group, and 18 who refused were allocated to the no-treatment group. Endometrial biopsy samples were also obtained.

MEASUREMENTS AND MAIN RESULTS

In women who received desogestrel, decidual transformation was observed in eight, glandular atrophy in three, and proliferative endometrium in five. In the no-treatment group, two women had menstruation, nine had proliferative endometrium, and seven had secretory endometrium. In the desogestrel group, the procedure was successful in all women. In the no-treatment group, the procedure was cancelled in two women because of menstruation and in four women with secretory endometrium in whom the tubal ostia were difficult to visualize because of endometrial thickness and bleeding. The median (interquartile range, 25th-75th percentile) duration of the procedure was shorter in the desogestrel group than in the no-treatment group (7 [6-7] minutes vs 8 [7-12] minutes; p = .002).

CONCLUSION

Desogestrel, 75 μg/d, could be an alternative to combined hormonal contraception before placement of Essure inserts, facilitating the procedure and serving as a contraceptive method during the following 12 weeks until occlusion of the tubes.