SYMPRES study

niche is a defect that can develop at the site a cesarean section scar. Approximately 60% of the women with aprevious cesarean section will develop such a niche. In 25% of the niches, a large symptomatic niche develops,with less than 3 mm of residual myometrium. This causes complaints such as abnormal uterine blood loss,dysmenorrhea, chronic pelvic pain and is related to infertility. Several hormonal therapies are available forgynecological complaints, such as oral anticonceptives, progesterone, intra-uterine device (IUD) with levenorgestrel. In case of failure of or contraindications to hormonal therapy, surgical intervention can be considered. Several innovative surgical therapies have been developed to treat niche-related symptoms, such as a laparoscopic niche resection. This treatment has been proven effective in the reduction of postmenstrual spotting and menstrual pain and its implementation in daily practice is increasing internationally. However,information on the effectiveness of this treatment in comparison with hormonal therapy in reduction of symptoms for women without a child wish, has not been studied yet. In the present study we aim to include women with a large niche and gynecological symptoms, randomize between a laparoscopic niche resection within 6 weeks(Intervention group) and hormonal therapy for nine months (Control group). After nine months, if the provided treatment is not effective enough, patients are eligible for additional surgical interventions.

Laparoscopic niche-resection is a superior treatment for symptomatic niches compared with hormonal therapy.

- 3, 6 months
- follow up 12, 24 months

Intervention: Laparoscopic niche resection performed within 6 weeks after randomization.
Control: Hormonal therapy (oral anticonceptives, progesterone, levenorgestrel IUD, GnRH agonist) for nine months.