Patient-Reported Tolerability, Treatment Initiation, and Discontinuation of Postoperative Progestin Therapy After Cesarean Scar Repair in Women Planning Pregnancy

Abstract

Background and Objectives: Cesarean scar disorder (CSDi) may require surgical repair in women with a large niche and thin residual myometrium. At our center, temporary postoperative progestin therapy is recommended to suppress cyclic endometrial proliferation and menstrual activity at the freshly reconstructed scar during early wound healing; whether this improves structural healing is unknown. We evaluated patient-reported treatment initiation, discontinuation, tolerability, bleeding patterns, mood-related symptoms, sexual behavior, and previous hormonal treatment experience in women planning pregnancy. Materials and Methods: This retrospective single-center cohort study included 74 women who underwent laparoscopic-assisted cesarean scar repair between 2020 and 2023. Seventy completed questionnaire follow-ups between March and October 2024 (response rate 94.6%). Hormonal exposure was patient-reported and included desogestrel, dienogest, or an unspecified progestin. Analyses were primarily descriptive and used item-specific denominators. Results: Among women with valid postoperative treatment information, 43/55 (78.2%) reported progestin use. Very-high motivation or a pregnancy-related motivation response was selected by 43/59 women (72.9%). Premature discontinuation because of adverse effects was reported by 15/61 (24.6%), and prolonged vaginal bleeding >14 days by 15/64 (23.4%). Mean perceived adverse-effect intensity was 3.43 (SD 2.99) on a 10-point scale. Fatigue, irritability, and depressed mood were the most frequently reported mood-related symptoms. Among women comparing the postoperative regimen with previous hormonal preparations, 20/32 (62.5%) reported no relevant difference in tolerability. Conclusions: Most women with available treatment information initiated postoperative progestin therapy, and motivation remained substantial despite an active desire for pregnancy. A relevant subgroup reported adverse-effect-related discontinuation or prolonged bleeding. These findings support careful pretreatment counseling and shared decision-making. The effects of postoperative hormonal suppression on anatomical healing and reproductive outcomes remain uncertain.