Get a clear view before starting: Endometrial preparation with hormones

Endometrial thickness is pivotal in allowing the best intracavitary conditions of a successful hysteroscopic procedure, whether diagnostic or operative. In fertile women who regularly menstruate, the procedure should be performed immediately after the menstrual cycle, in the early follicular phase, when the endometrium is expected to be the thinnest. However, the logistics of scheduling and performing hysteroscopic surgery during this short window may raise problems. Several molecules, such as gonadotropin-releasing hormones analogs (GnRH-a), danazol, progestins given alone or combined with estrogens, have been proposed as treatments for endometrial preparation before hysteroscopy. An adequate preoperative endometrial treatment improves the safety and feasibility of the procedure, lowering the risks and increasing the success rate. This chapter aimed to provide updated evidence regarding the pros and cons of the available therapeutic agents frequently used for endometrial preparation before hysteroscopic procedures.