|Reduced endometrial thickness||Cost|
|Reduced endometrial debris|
|Reduced uterine vascularity||Side effects|
|Reduced operating time||Delays surgery|
|Reduced fluid absorption||Higher recurrence of fibroids|
|Stop the bleeding to improve the patient haemoglobin before surgery|
How to prepare the endometrium
1) Timing (e.g. surgery after period) – the endometrium is thinnest after menses and thickest in the second half of the cycle.
2) Medical (e.g. GnRH analogue, danazol, progestogens, COC) – different pharmacological preparations have been used to produce a thin atrophic endometrium. The choice of any priming agent should be based on cost, side effects and local practice. There are few data available from randomised trials to assess the value of progestogens. There is no difference in complication rate between danazol and GnRHa but a reduction in fluid deficit and operating time has been noted with the latter. Ulipristal acetate (Esmya) can help before resection of a fibroid although as it makes the endometrium thicker it is therefore not suitable for preparation before endometrial resection.
3) Nothing – this is generally the case when performing operative hysteroscopic procedures in an outpatient one-stop clinic setting, especially if the pathology is small (e.g. polyp).