Comparison to other literature
The reduction effect of hysteroscopic niche resection on spotting in our
study are in line with previous studies reporting a median reduction of
4 days at 3 to 6 months follow-up.11, 12, 17 Only one
small study including only 6 patients evaluated the effect of LNG-IUD on
spotting and reported a beneficial effect.18 None of
the previous studies compared both interventions and none of these
studies evaluated the changes in effectiveness over time in this
population.
In a general population approximately 20% of amenorrhea is reported one
year after insertion of LNG-IUD.22-25 In our
population of regular menstruating patients with spotting and a niche,
the rate of amenorrhea was higher, 39% at one-year follow up. Previous
studies also reported higher rates, up to 25% of irregular bleeding 6
months after LNG-IUD insertion26, while only 11% or
our patients reported irregular bleeding in the LNG-IUD group.
The strict clear selection criteria may have played a role in the
reported differences between our study and previous studies, since women
with an irregular menstrual cycle or endometrial atypia were exclusion
criteria in our study. This is in line with the fact that previous
studies have found in inverse relation between the thickness of the
endometrium and the amenorrhoic
rate.19, 27 In our
study the proportion of women with amenorrhea increased over time, this
is also in line with previous
studies.19, 27