Systematic Review

Gynecol Obstet Invest 2021;86:209–217 Received: June 12, 2020

Accepted: January 19, 2021
DOI: 10.1159/000514584 Published online: May 5, 2021

Oral Desogestrel as Endometrial

Preparation before Operative
Hysteroscopy: A Systematic Review
Michał Ciebiera a Magdalena Zgliczyńska a Stanisław Zgliczyński b
     

Antoni Sierant c Antonio Simone Laganà d Luis Alonso Pacheco e

     

Jose Carugno f Salvatore Giovanni Vitale g

   

aSecond Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw,

Poland; bDepartment of Internal Diseases and Endocrinology, Central Teaching Clinical Hospital, Medical University
of Warsaw, Warsaw, Poland; cEndoscopic Simulation Center, The Center of Postgraduate Medical Education,
Warsaw, Poland; dDepartment of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria,
Varese, Italy; eUnidad de Endoscopia Ginecológica, Centro Gutenberg, Málaga, Spain; fObstetrics and Gynecology
Department, Miller School of Medicine, University of Miami, Miami, FL, USA; gObstetrics and Gynecology Unit,
Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy

Keywords
Desogestrel · Endometrium · Hysteroscopy · Endoscopy ·
Preparation · Progestin
Abstract
The pharmacologic preparation of the endometrium before
hysteroscopy may be achieved with the use of various drugs.
This systematic review aims to summarize the available evi-
dence regarding the use of desogestrel for endometrial
preparation before hysteroscopic procedures. A literature
search for suitable articles published in English language
from inception of the database until August 2019 was per-
formed using the following databases: PubMed/MEDLINE,
EMBASE, the Cochrane Library, and Google Scholar. All orig-
inal articles concerning desogestrel-only pretreatment be-
fore hysteroscopic surgery were considered eligible. Re-
views, case reports/series, conference papers, studies in-
cluding the use of combined hormonal preparation, and
articles in languages other than English were excluded from
the analysis. The literature search retrieved 3 studies that
met all the inclusion criteria. The data demonstrated that
desogestrel may be considered as a hormonal pretreatment
drug before hysteroscopic procedures. The drug was dis-
tinctly effective and assessed as helpful by the operating sur-
geon in numerous patients who were administered the pre-
treatment of 75 μg daily. Oral desogestrel is a cheap, easily
available, safe, and quite efficient alternative for endome-
trial preparation before hysteroscopic procedures.
© 2021 S. Karger AG, Basel
Introduction
Hysteroscopy is considered the current gold standard
procedure for the diagnosis and management of intra-
uterine pathology [1–3]. This technique is commonly
performed to collect targeted endometrial biopsies under
direct visualization [4] or to treat intrauterine conditions
such as endometrial polyps, fibroids, intrauterine adhe-
sions, and for the correction of various müllerian malfor-
mations [5–8]. Currently, technological advances of this
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karger@karger.com © 2021 S. Karger AG, Basel Correspondence to:

www.karger.com/goi Salvatore Giovanni Vitale, sgvitale @ unict.it
Glasgow Univ.Lib.
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technique with miniaturization of the instruments and
improvement of the optics have allowed to safely perform
hysteroscopy in an office setting causing only minimal or
no patient’s discomfort [9–13].
Although considered a safe procedure, hysteroscopy is
not free of complications. Known complications’ risks of
hysteroscopy include uterine perforation, bleeding, se-
vere pain, infection, cervical laceration, venous air embo-
lisms, or fluid overload [9, 14, 15]. Strategies to decrease
the complication rate during hysteroscopic procedures is
a subject of continuous research [16].
Several strategies aiming to simplify hysteroscopic
procedures are under investigation [17]. Endometrial
pharmacologic preparation has been utilized before hys-
teroscopy with the intention to suppress endometrial
growth so that the endometrium becomes thin, improv-
ing hysteroscopic visualization inside the endometrial
cavity [18–23]. Current research focuses on the use of
combined oral contraception (COC) containing estrogen
and progestins, such as estradiol valerate combined with
dienogest [24]. A recent publication concluded that short
endometrial pretreatment with COC has a favorable im-
pact on the improvement of the overall outcomes of op-
erative hysteroscopy [19]. In 2006, similar results were
published by Triolo et al. [25] who used gestrinone and
danazol, concluding that both agents were effective in the
endometrial preparation for operative hysteroscopy. The
effectiveness of danazol was also confirmed for this indi-
cation by Florio et al. [26], who stated that danazol ade-
quately prepared the endometrium for operative hyster-
oscopy with a minor impact on metabolic parameters.
However, the amount of data concerning the use of the
progestin-only approach in the endometrial pretreat-
ment before hysteroscopic procedures is limited. The use
of other progestin agents such as dienogest for endome-
trial preparation before hysteroscopic procedures had al-
ready been the aim of review articles. In a recent system-
atic review published by Laganà et al. [27], dienogest pre-
treatment reduced the operative time, infusion volume,
and the severity of bleeding during the procedure. There-
fore, aiming to determine the best pharmacologic agent
for endometrial preparation before hysteroscopic proce-
dures, the use of other progestin agents should also be
investigated.
Desogestrel is a synthetic estrane steroid derivative of
testosterone, which is an agonist of the progesterone re-
ceptor. It has a biological effect similar to that of proges-
terone, with weak androgenic and glucocorticoid prop-
erties [28, 29]. Desogestrel is a prodrug of etonogestrel,
and it triggers its effect on steroid receptors via this me-
210 Gynecol Obstet Invest 2021;86:209–217
DOI: 10.1159/000514584
tabolite [29]. It is widely used as a contraceptive method
(so-called “mini-pill”) [30]. Its major advantage is the re-
duced androgenic activity, compared to numerous other
available progestins. Furthermore, desogestrel has a good
safety profile and the drug tolerance is usually good with
only minimal side effects including weight gain, irregular
uterine bleeding, amenorrhea, headache, dysphoria, loss
of libido, or acne [28, 31]. The pharmaceutical market
offers desogestrel alone in the form of 75 μg oral tablets
[30] and at higher doses in combination with ethinyl-
estradiol [32]. Desogestrel has a strong antigonadotropic
effect with a major functional antiestrogenic effect on the
vaginal epithelium, cervical mucus, and endometrium
[28, 29, 33]. It causes ovarian suppression, and with its
antiestrogenic effect on the endometrium, it keeps the
uterine lining thin [34]. The abovementioned effect (en-
dometrial hypotrophy) appears to be particularly inter-
esting in the area of its possible use in operative hyster-
oscopy.
A study of desogestrel 75 μg/day for a total of 6 weeks
showed a spectrum of endometrial changes in biopsies
including proliferative endometrium, decidual transfor-
mation, and glandular atrophy [30]. Scientific evidence
demonstrated that desogestrel highly suppresses ovula-
tion, while norethisterone at this dose was found to in-
hibit ovulation only 35% of the time [35].
Available data are insufficient to help the clinician to
determine the most effective hormonal drug for endome-
trial pretreatment before hysteroscopic procedures [16].
This review aims to summarize the available published
data describing the use of desogestrel as a method of en-
dometrial preparation before operative hysteroscopy.
Methods
The design, analysis, interpretation of data, drafting, and revi-
sions followed the PRISMA Statement [36]. This systematic review
was registered in PROSPERO (CRD42017067077).
A systematic literature search was conducted using the follow-
ing databases: PubMed/MEDLINE, EMBASE, the Cochrane Li-
brary (the Cochrane Database of Systematic Reviews, the Co-
chrane Central Register of Controlled Trials [CENTRAL]), and
Google Scholar for research articles concerning the use of desoges-
trel-only for the pretreatment of the endometrium before hystero-
scopic surgery published in English language from the inception
of the consulted databases until August 2019. A full electronic
search strategy for all used databases is available in Table 1. The
last search was performed on August 11, 2019. All original articles
(randomized, observational, and retrospective studies) were con-
sidered eligible. Review articles, case reports/series, conference pa-
pers, and articles in languages other than English were excluded
from the analysis. We have also excluded studies regarding endo-
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 Records identified through Additional records identified

Identification
database searching through other sources
(n = 323) (n = 0)

Records after duplicates removed

(n = 311)

Screening
Records screened Records excluded
(n = 311) (n = 305)

Eligibility Full-text articles assessed Full-text articles excluded

for eligibility with reasons
(n = 6) (n = 3)
conference paper –2
study does not report
demanded data –1
Studies included in
Included

qualitative synthesis
(n = 3)

Fig. 1. PRISMA flowchart.

Table 1. Full electronic search strategy used for the systematic literature search

Database Search strategy Results,

n

PubMed (“Desogestrel” [Mesh] OR desogestrel) AND (“hysteroscopy” [Mesh] OR hysteroscopy OR uterine 4

endoscopy)
EMBASE (desogestrel OR dezogestrel) AND “hysteroscop*” AND (“human”/exp OR “human”) AND [female]/ 9
lim AND (“article”/it OR ′article in press”/it) AND [english]/lim
CENTRAL #1 “hysteroscopy” [Mesh] 5
#2 hysteroscop* OR uterine endoscopy
#3 “Desogestrel” [Mesh]
#4 desogestrel OR dezogestrel
#5 (#1 OR #2) AND (#3 OR #4)
Google Scholar Desogestrel AND hysteroscopy AND (preparation OR pretreatment OR “pre treatment” OR 305
preoperative OR “pre operative” OR thinning)

metrial pretreatment with the use of combined hormonal prepara-
tions. No restrictions were used in the year of publication. There
was no need to contact the authors of selected works to obtain ad-
ditional information.
Titles and/or abstracts of retrieved articles that met the inclu-
sion criteria were screened independently by 2 authors (A.S. and
M.Z.). The full texts of potentially eligible studies were reas-
sessed for eligibility by the other 2 authors (M.C. and S.Z.). Any
disagreement was resolved through discussion and consensus
with other authors (A.S.L., L.A.P., and J.C.). The PRISMA flow-
chart and search strategy are summarized in Figure 1. For each
study, 3 authors (M.C., M.Z., and S.Z.) extracted information
including the baseline characteristics of participants, study set-
ting, the details of the intervention and control conditions, study
methodology, recruitment, outcomes, and the suggested mecha-
nisms of intervention action. Two authors (A.S.L. and S.G.V.)
independently assessed the risk of bias in the included studies
with the use of the Cochrane Collaboration’s tool for assessing
the risk of bias in randomized trials and ROBINS-I: a tool for
assessing the risk of bias in nonrandomized studies of interven-
tions (Table 2).
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Table 2. Risk of bias assessment

Study Type of the Bias Authors’s Support for judgment Summary

study judgment assessment

Cicinelli et Randomized Random sequence Low risk Computer-generated randomization Low risk
al. [37] generation (selection
bias)
Allocation concealment Unclear risk The randomization list was computer generated, but further
(selection bias) description of allocation is not included
Blinding of participants Unclear risk Not described in the text
and researchers
(performance bias)
Blinding of outcome Low risk Endometrial thickness in pretreatment and treatment cycle were
assessment (detection assessed by the same investigator. Doctors performing
bias) ultrasound and surgery were blinded to the treatment performed
Incomplete outcome Low risk From 145 women, investigators excluded 55 patients with large
data (attrition bias) or multiple polyps, myomas, adhesions, septa, or uterine
position prevented a reliable endometrial thickness
measurement or if no dominant follicle was detected
Selective reporting Low risk All prespecified outcomes were reported
(reporting bias)
Other bias Low risk Researchers made an assumption that no natural variation in
endometrial thickness occurs in different cycles; however, it is
unlikely to be a major bias
Haimovich Non- Bias due to confounding Moderate risk All participants were offered desogestrel. Sixteen who accepted Moderate
et al. [34] randomized were included in the desogestrel group, and 18 who refused were risk
allocated to the no-treatment group, which is probably not the
source of major confounding bias
Bias in selection of Moderate risk Exclusion of patients and outcome events were not related to
participants into the both intervention and outcome
study
Bias in classification of Moderate risk Both groups were comparable insofar as age, parity, and
interventions indications
Bias due to deviations Moderate risk Information provided in the study suggest that there were no
from intended systematic differences between experimental and comparator
interventions group in intervention applied
Bias due to missing data Serious risk Follow-up data are missing

Bias in measurement of Moderate risk Assessment of outcomes were performed in the same way for
outcomes each group. All office hysteroscopic procedures were performed
by the same examiner; however, it was not stated if he was aware
of intervention status. Histologic specimens were examined by a
pathologist blinded to the purpose of the study
Bias in selection of the Low risk All prespecified outcomes were reported
reported result
Lagana et Randomized Random sequence Low risk Computer-generated randomization Low risk
al. [38] generation (selection
bias)
Allocation concealment Low risk Study drugs were in consecutively numbered, sealed boxes
(selection bias)
Blinding of participants Low risk Patients and investigators were blinded to treatment allocation
and researchers
(performance bias)
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Table 2 (continued)
Study Type of the Bias Authors’s
study judgment
Blinding of outcome Low risk
assessment (detection
bias)
Incomplete outcome Low risk
data (attrition bias)
Selective reporting Low risk
(reporting bias)
Other bias Low risk
Results
The literature search retrieved 3 studies that met the
inclusion criteria [34, 37, 38]. The selected studies indi-
cated that desogestrel may be beneficial in endometrial
preparation before hysteroscopy. The results of those
studies are summarized in Table 3.
Cicinelli et al. [37] performed a randomized trial, en-
rolling 90 women (3 groups of 30) to estimate the effec-
tiveness of a daily intake of 75 μg/day of oral desogestrel
with a 60-mg tablet of raloxifene hydrochloride adminis-
tered intravaginally every day at bedtime, with a group of
75 μg/day of oral desogestrel-only and a group of oral
danazol-only taken at a dose of 200 mg, 3 times a day.
Each woman was taking the medications for 9 days start-
ing on day 1 of the subsequent menstrual cycle regardless
of the group to which she was assigned. Groups were
found to be homogeneous as regards the endometrial
thickness in the follicular phase. The endometrial surface
appeared hypotrophic after the pretreatment in all the
participants. The quality of a clear view of the uterine cav-
ity during the hysteroscopic procedure and total surgeon
satisfaction (visual analog score) were most significantly
improved in the desogestrel plus raloxifene group com-
pared to other groups. Finally, the authors reported no
adverse effects during the treatment with desogestrel and
raloxifene. In the desogestrel-only group, 13.3% of wom-
en reported spotting, whereas the majority of danazol
group participants reported the most substantial number
of side effects (headaches, nausea, and bloating) [37].
More recently, the beneficial effects of the preopera-
tive administration of desogestrel before a hysteroscopic
procedure were reported by Haimovich et al. [34] who
performed a nonrandomized study, as described below.
A group of 34 women undergoing sterilization using the
Essure system were enrolled in the study: 16 participants
Oral Desogestrel before Hysteroscopy
Support for judgment Summary
assessment
Hysteroscopic surgery was performed by physician unaware of
the treatment
No attrition bias was noticed
All prespecified outcomes were reported
We did not notice other sources of bias
were assigned to the study group and 18 to the control
group (without treatment). Participants assigned to the
study group were administered desogestrel 75 μg daily for
6 weeks before hysteroscopy. The objective of the study
was to assess the effect of desogestrel as a method of en-
dometrial preparation before the Essure sterilization pro-
cedure. One of the main inclusion criteria was the pres-
ence of any contraindications to the use of oral contracep-
tives containing ethinylestradiol or patient refusal to use
COC. The duration of hysteroscopy was significantly
shorter in women in the desogestrel group. Adequate en-
dometrial preparation was reported in 100% of women
treated with desogestrel, compared to 50% in the controls
(p = 0.001). As reported by the authors, the Essure steril-
ization procedure was successfully performed in 100% of
women who were pretreated in the desogestrel group and
67% in the control group (p = 0.020). Difficulties with vi-
sualization of the tubal ostium due to excessive endome-
trial thickness and bleeding were reported in 4 women in
the control group. According to the authors, desogestrel
was found to be a valuable endometrial thinning agent for
endometrial preparation before hysteroscopic tubal ster-
ilization [34].
Finally, in 2014, Laganà et al. [38] presented their re-
sults of another randomized trial where they compared
oral desogestrel to danazol as pretreatment before hys-
teroscopic surgery. In this study, all the patients were se-
lected from a population with suspected uterine pathol-
ogy, based on the results of previous transvaginal ultra-
sound screening. All the patients underwent a diagnostic
hysteroscopy before the final procedure. The authors en-
rolled 200 patients with various uterine diseases and di-
vided them into 2 groups of 100 patients each. In this
study, endometrial characteristics were assessed via vi-
sual observation and confirmed by a pathologist. One
group of patients were treated with oral desogestrel 75 μg
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 Table 3. Characteristics of the included studies

214
Authors Year Type of study Enrolled Indication Groups Surgical procedure and equipment Main outcomes
cases

Cicinelli et 2007 Randomized 90 Endometrial – A-30 Diagnostic hysteroscopy performed via – The groups were found to be
al. [37] prospective study polyp – 75 μg/day of oral desogestrel vaginoscopic approach using a lens- homogeneous as regards endometrial
– Plus a 60-mg tablet of based 2.7-mm outer-diameter mini- thickness in the follicular phase
raloxifene telescope, equipped with a 3.5-mm – Endometrial thickness after treatment
– Hydrochloride outer-diameter single-flow diagnostic was significantly smaller in group A
– B-30 sheath compared to both B and C (p < 0.001)
– 75 μg/day of oral desogestrel Polypectomy performed using a – Average percentage reduction in
– C-30 monopolar resectoscope under local endometrial thickness in the women of
– 3×200 mg/day of oral danazol anesthesia group A– significantly greater reduction
26-F resectoscope with continuous-flow, than seen in the other groups (p < 0.001)
cutting loop electrode at a power setting – Surgeon satisfaction significantly higher
of 120 W for women of group A compared to the

DOI: 10.1159/000514584
other groups (p < 0.001)
– No side effects were reported by the
women of group A. In group B, 4 (13.3%)
women reported spotting. In group C, 2
(6.7%) women reported headache, 3 (10%)

Gynecol Obstet Invest 2021;86:209–217

nausea, and one (3.3%) bloating
Haimovich 2013 Nonrandomized 34 Essure A–16 Hysteroscopic procedures were – Adequate endometrial preparation was
et al. [34] prospective study Hysteroscopic 75 μg/day of oral desogestrel performed using a 4.3-mm continuous- achieved in 100% of women treated with
Sterilization B–18 control flow office hysteroscope with a 2.9-mm- desogestrel, compared to 50% of women
rod lens optic in the nontreatment group (p < 0.001)
The Essure microinserts were delivered – The procedure was successfully
through a 5-F hysteroscope working performed in 100% of women in the
channel desogestrel group and in 67% in the
Biopsy specimen was obtained after the nontreatment group (p = 0.020)
procedure – The median level of patient satisfaction
with the procedure was similar in both
study groups
Laganà et 2014 Randomized 200 Endometrial A–100 Hysteroscopic procedures were – The group treated with desogestrel had a
al. [38] prospective study polyp 75 μg/day of oral desogestrel performed using a rigid hysteroscope larger number of patients who showed
Uterine septum B–100 with the outer diameter of 10 mm hypotrophic or atrophic patterns (p =
Uterine fibroids 100 mg/day of oral danazol 0.031)
Isthmocele – There was no difference in the dilation
Asherman’s time of the cervix between the groups (p =

Ciebiera et al.
syndrome 0.160)
– Desogestrel group was characterized by
shortened duration of the surgery (p =
0.020), lower infusion volume (p = 0.012),
and smaller bleeding (p = 0.004)
– Patients treated with desogestrel had
fewer side effects in comparison with the
danazol group (8 vs. 26, p = 0.031)
– Follow-up after 4 weeks presented no
alteration of the thickness of the
endometrium in any of the patients

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daily for 5 weeks, and the other group received 100 mg of
oral danazol daily for the same period. During hysteros-
copy, the surgeon classified the endometrium into 3 types
and collected biopsy specimens to confirm the hystero-
scopic appearance of the endometrial pattern by histolo-
gy. The authors confirmed the atrophying effect on the
endometrium of both danazol and desogestrel. However,
the effect was greater in the desogestrel group in com-
parison with danazol (p = 0.031). Another finding was
that desogestrel determined a greater reduction of bleed-
ing patterns (p = 0.004), allowed a shorter procedure time
(p = 0.020), and lower volume of infused distention media
to complete the procedure, respectively (p = 0.012).
Desogestrel was also found to be safer than danazol with
fewer side effects in total (p = 0.031) [38].
Discussion
The first study cited in this review, published by Cici-
nelli et al. [37], confirmed the effectiveness of desogestrel
as pretreatment before hysteroscopy. The major finding
of this study was that the combination of oral desogestrel
and vaginal raloxifene provided very fast and effective en-
dometrial thinning. Desogestrel alone achieved poorer
results than desogestrel combined with raloxifene. How-
ever, the comparison with danazol was favorable. The au-
thors emphasized that the main inconvenience associated
with desogestrel was a high rate of spotting (10%) in pa-
tients who had endometrial polyps. Regarding the limita-
tions of the study, the authors assumed that no natural
variation in endometrial thickness occurred when cycles
of different lengths were compared in terms of the same
cycle day. The second major limitation was the lack of a
raloxifene-only arm [37]. Furthermore, the study includ-
ed only patients with uterine polyps. Moreover, long-
term outcomes regarding side effects were not reported,
as the authors provided data that covered only the first 2
h following the procedure. In conclusion, the authors in-
dicated marked effectiveness of a combination of various
substances – in this case of desogestrel combined with
raloxifene [37].
The second study included in the present systematic
review and published by Haimovich et al. [34] showed the
considerable advantages of desogestrel in terms of appro-
priate endometyrial preparation of patients undergoing
the insertion of Essure® tubal sterilization coils. As previ-
ously mentioned, the study showed a favorable effect of
desogestrel during the hysteroscopic procedure for Es-
sure® insertion. The main limitation of this study was the
Oral Desogestrel before Hysteroscopy
fact that the hysteroscopic procedures were performed
only with the aim of insertion of the permanent steriliza-
tion implants. Therefore, it may not be deemed fully com-
parable with operative hysteroscopy. Moreover, the sam-
ple size was small, and the study design included no ele-
ments of randomization and lacked standardization in
objective measurements. Moreover, the study contains
no data concerning bleeding profiles and possible uterine
pathologies in patients before progestin treatment. Their
potential effect on the course of the procedure was not
mentioned [34]. Importantly, Haimovich et al. [34] em-
phasized that not every patient may be administered es-
trogens in general and highlighted the need to solve this
problem. However, at the same time, it is known that pro-
gestins are more acceptable drug in certain groups of pa-
tients [39].
The last study included in the present systematic re-
view also compares the use of desogestrel to danazol for
pretreatment before hysteroscopy [38]. The authors dem-
onstrated the advantage of using 75 μg of desogestrel dai-
ly over 100 mg of danazol as pretreatment before hyster-
oscopy. The patients operated after desogestrel pretreat-
ment obtained better results in hysteroscopy: shorter
operative time and a lower volume of distension medium.
Moreover, the patients experienced fewer side effects.
The sample size was appropriate and the conclusions
seem robust. We consider that most of the study method-
ology is appropriate. The outstanding feature of this study
is the broad spectrum of diseases included in the analysis.
The main limitation of this study is the relatively low dose
of danazol (100 mg daily) used [38]. Cicinelli et al. [37]
used a 6-fold higher dose of 600 mg of danazol in endo-
metrial pretreatment in their study.
The reviewed articles demonstrated that desogestrel
may be considered as a hormonal pretreatment drug be-
fore hysteroscopic procedures. The drug was effective
and assessed as helpful by the operating surgeon in nu-
merous patients. Nevertheless, more effective drugs (or
combinations of drugs) are also available, as was reported
by Cicinelli et al. [37], who used desogestrel combined
with raloxifene.
It should not be disregarded that desogestrel also has
2 major advantages, one being its contraceptive function
[31]. It facilitates the optimal preparation of the patient
for the procedure, simultaneously avoiding the risk of un-
intended pregnancy. Oral desogestrel is characterized by
good contraceptive efficacy and is well tolerated. Proges-
tin-only pills (e.g., desogestrel or drospirenone) are not
associated with an increased risk of venous thrombosis
and are the oral contraceptive method of choice in wom-
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en who are at an increased risk of the disease. However, oscopy. The use of desogestrel seems attractive while the
according to Scala et al. [40], the use of desogestrel in available data suggested that oral desogestrel might be an
some patients might be associated with a small higher risk efficient alternative for endometrial preparation before
of venous thromboembolism compared to second-gener- hysteroscopic procedures, especially in a group of women
ation progestins (e.g., levonorgestrel). Another distinct with contraindications to estrogen derivatives. The ideal
but important advantage of desogestrel is its wide avail- duration of pretreatment is still to be determined, and
ability and low price, which is important when selecting more randomized studies on larger groups are necessary.
a drug [37].
To the extent of our knowledge, the current systematic
review is the first article that summarizes the evidence in Statement of Ethics
this matter. The major limitation of this review is still a
This article does not contain any studies with human partici-
relatively small number of studies investigating its poten-
pants or animals performed by any of the authors.
tial role for this purpose (only 3 studies were retrieved
through an extensive literature search). Moreover, they
included heterogeneous populations, indications for hys- Conflict of Interest Statement
teroscopy, as well as specific procedures performed. Nev-
ertheless, the quality of the research was satisfactory – 2 of The authors have no conflicts of interest to declare.
the studies included in the review were characterized by
low bias risk, whereas one by moderate bias risk (Table 1).
This review also highlights the fact that there is lack of sci- Funding Sources
entific interest regarding pharmacologic endometrial
preparation before hysteroscopic procedures. We hope No specific funding was obtained for this study.
that with this overview, clinicians will consider using dif-
ferent endometrial preparations including desogestrel-
based option prior to operative hysteroscopic procedures. Author Contributions

M. Ciebiera: project development, data collection and manage-

Conclusion
Hormonally active agents and their appropriate selec-
tion depending on individual patient characteristics may
constitute a good method of pretreatment before hyster-
ment, manuscript writing, and final approval. A. Sierant: data col-
lection and management and manuscript writing. M. Zgliczyńska:
data collection and management and manuscript writing. S.
Zgliczyński: data collection and management. A.S. Laganà: manu-
script editing. L. Alonso: manuscript editing. J. Carugno: manu-
script editing. S.G. Vitale: manuscript editing, project supervision,
and final approval.

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