Design: Multicenter, prospective, randomized controlled trial.

Setting: University hospitals.

Patients or Participants: A total of 80 adult women undergoing office hysteroscopic polypectomy between January 2023 and March 2024 were randomized to the intervention group (n = 40) or the control group (n = 40). Exclusion criteria included the presence of endouterine pathology other than endometrial polyps exclusively.

Interventions: Subjects in the intervention group were treated with oral nomegestrol acetate/estradiol 1.5mg/2.5mg/day, initiated at an unspecified time in the menstrual cycle (random start) for 14 days. Subjects in the control group did not receive any pharmaceutical treatment and underwent polypectomy between days 8 and 11 of the menstrual cycle.

Measurements and Main Results: On the day of the procedure, the difference in pre- and post-office hysteroscopic polypectomy endometrial ultrasound thickness was statistically significant between the two groups, with the endometrial thickness in both measurements being thinner for the intervention group (p < 0.001). In the nomegestrol acetate/estradiol-treated group, compared with the control, there were more women who showed ''atrophic'' or ''hypotrophic with normotrophic area” endometrial pattern (p < 0.001). There was also a statistically significant difference in the surgeon's assessment of the quality of endometrial preparation (p < 0.001), the quality of visualization of the uterine cavity during the procedure (p < 0.001), and satisfaction with the performance of the procedure (p < 0.001). Subjects in the intervention group also experienced less pain both during and after the procedure (p < 0.001). Finally, all surgical outcomes analyzed were better in the treatment group.

Conclusion: Treatment with nomegestrol acetate/estradiol could offer rapid, satisfactory, and cost-effective preparation of the endometrium before office polypectomy, thereby enhancing surgical performance and women's compliance.