Taxa de gravidez em mulheres submetidas à miomectomia histeroscópica / Pregnancy rate in women undergoing hysteroscopic myomectomy

Esta revisão tem como objetivo determinar o efeito da miomectomia histeroscópica sobre a performance reprodutiva de mulheres, com leiomiomas submucosos, tentando engravidar há, pelo menos, 12 meses e sem outras causas definidas de infertilidade. Foram revistos estudos clínicos controlados e randomizados (ECCR) publicados entre janeiro de 2005 e agosto de 2015 nas bases de dados MEDLINE (National Library of Medicine) e a Biblioteca Cochrane. Os desfechos examinados foram a taxa geral de gravidez, taxa de gravidez por tipo de leiomioma submucoso e tempo médio entre a intervenção e a gravidez. As publicações mostraram resultados favoráveis à realização da miomectomia histeroscópica quando comparada à não ressecção do leiomioma, atingindo taxas gerais de gravidez de até 63,4% no grupo intervenção e de apenas 28,2% no grupo controle. Resultados semelhantes ainda foram obtidos quando avaliadas as taxas de gravidez por tipo de leiomiomas submucosos. Apenas um estudo avaliou o tempo médio entre intervenção e gravidez, evidenciando redução significativa deste desfecho nas pacientes submetidas ao procedimento cirúrgico. Um importante benefício com a miomectomia histeroscópica não pode ser excluído nessas pacientes sugerindo um aumento nas taxas de gravidez quando essa cirurgia é realizada. Porém, mais ensaios clínicos controlados e randomizados são necessários para comprovar tal benefício.(AU)

This review aim to determine the effect of hysteroscopic myomectomy on reproductive performance of women with submucosal fibroids trying to conceive for at least 12 months and with otherwise unexplained infertility. The analysis was limited to only randomized controlled clinical trials (RCTs) published between January 2005 and August 2015, with reference to the MEDLINE database (National Library of Medicine) and the Cochrane Library. The selected endpoints were overall pregnancy rate, pregnancy rate by type of submucosal fibroids and mean time between intervention and pregnancy. The studies showed favorable results performing hysteroscopic myomectomy when compared to no resection of the fibroid, reaching overall pregnancy rates of up to 63,4% in the intervention group and only 28,2% in the control group. Similar results were also obtained when evaluated pregnancy rates by the type of submucosal fibroids. Only one study evaluated the mean time between intervention and pregnancy, showing significant reduction in this outcome in patients undergoing the surgical procedure. An important benefit with hysteroscopic myomectomy cannot be excluded in these patients, suggesting an increase in pregnancy rates when the surgery is performed. But more randomized controlled clinical trials are needed to confirm this benefit.(AU)

Clinical assessment of ethinylestradiol and cyproterone acetate in menstrual irregularities of hyper-androgenic origin / Avaliação clínica do uso de duas preparações de etinilestradiol e acetato de ciproterona em menstruação irregular de origem hiperandrogênica

We report on the results of a double-blind, randomized, controlled clinical trial comparing two preparations of ethinylestradiol and cyproterone acetate in the treatment of women of reproductive age presenting menstrual irregularities of hyper-androgenic origin. After obtaining informed consent, subjects were randomized to a 4-month treatment period consisting of one daily dose of 0.035mg ethinylestradiol + 2mg cyproterone acetate. The treatment regimen cycle consisted of one pill, once daily for 21 days, followed by a 7-day pill-free period. We compared the efficacy of two presentations of the drug combination after each treatment cycle (Visits 2, 3, 4, and 5) in establishment and maintenance of menstrual regulation, intensity of menstrual flow, and dysmenorrhea, as well as a comparison of the two presentations in terms of Global Satisfaction and Drug Satisfaction assessments performed by the patients and the investigating physician. At each study visit, drug compliance and use of concomitant medications, as well as incidence, severity and duration of adverse events were recorded. A total of 86 subjects were randomized to treatment, with 43 subjects in each treatment group. At Visit 2 and each subsequent visit, all patients in both treatment groups reported an episode of withdrawal bleeding during the 7-day hormone-free period. We observed a statistically significant (p<0.0001) decrease in the incidence of dysmenorrhea at each study visit in relation to the pretreatment assessment. There was a significant reduction (p<0.0001) in the number of subjects reporting intermenstrual bleeding at each study visit in both treatment groups. Global Satisfaction scores by the patient and physician increased significantly at each successive study visit in both treatment groups. There were no clinically significant changes in vital signs, weight, and body mass index throughout the study period in either group. The number of subjects reporting adverse events at each visit did not vary between treatment groups. The combined oral contraceptive pill containing ethinylestradiol and cyproterone acetate was found to be both effective and safe in the menstrual irregularities of hyper-androgenic origin (amenorrhea, dysmenorrhea, and intermenstrual bleeding) assessed in this study.