الفهرس 
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Abstract
Progestin-only contraception (POC) is widely used nowadays. This can be attributed to the absence of side effects and complications of estrogen, it doesn’t interfere with lactation, and increasing interest in long-acting reversible contraception (LARC). mechanisms of action include altering the biophysical characteristics of cervical mucus, decreasing cilia motility and the muscle contractile force of the fallopian tubes, inhibiting, or lowering the peaks of LH and FSH in the mid-cycle that may lead to inhibition of ovulation with variable percentages, and altering endometrial receptivity.
Undesirable and distressing forms of AUB with POC are significantly more common if compared to other methods. For instance, about 40% reported vaginal bleeding or spotting that led to discontinuation in 25% of POP users. There is a great need for an investigating tool to study the endometrial cavity changes and document FallopianTube effects of POC.
Since a long time, office hysteroscopy (OH) has been widely implemented in investigating the endometrial cavity in many gynecologic diseases, e.g., AUB unexplained infertility, and RPL. It would be more valuable if this method answered the question of why AUB is frequently diagnosed in POC users.
In recent years, we have extensively studied the proximal part of the FT functions using the bubble flow test and the physiologic peristalsis via OH. Moreover, the combination of the bubble flow test and peristalsis (Darwishscope test) was proved to be superior to either test alone for better evaluating the function of the proximal part of the FT.This study aims to assess the endometrial changes and proximal FT functions in symptomatizing patients using POC compared to non-users of any hormones utilizing OH.
Patients and Methods
This cross-sectional prospective study was performed at the OH Unit of the Woman’s Health University Hospital, Assiut, Egypt between September 2021 and May 2023 One-hundred forty women subjected to office hysteroscopy (OH) were classified into 2 groups.
group A included 70 women using POC while group B included non-hormone user. subjected to OH for different indications. Preoperative counselling of all patients followed by an informed written consent taken from those who agreed. All patients were subjected to complete history taking particularly contraceptive history therapeutic history, and meticulous physical examination.
Selected cases were subjected to OH at the OPD. The vulva, vagina and the thighs were disinfected with a 10% povidone-iodine solution. Sterile draping was applied. OH was performed using a 2.6 mm 30° rigid scope with a 3.2mm outer sheath (Karl Storz, Tuttlingen, Germany). At the beginning, in all cases, vaginoscopic approach was tried but if any difficulty was encountered, grasping of the anterior lip of cervix with a multi-toothed volsellum was done. Thereafter, the uterus was distended with normal saline at 60-80 mmHg generated from a pneumatic cuff of sphygmomanometer wrapped around the 500 CC infusion bottle.
As attached to a 250-W Xenon light source, the scope was introduced gently through the cervical canal and internal os. To perfectly perform hysteroscopic assessment of the endometrial cavity, the following tricks were followed. Clear view of the endometrial cavity should be achieved on panoramic view by placing the hysteroscope at internal os waiting for a while to achieve homogenous distension and efflux of blood clots from the cervix. The uterine cavity should be systematically examined starting by its anterior and posterior walls, the fundus, and the borders. Examination was considered complete if both tubal ostia was reached. comments on the endometrial thickness and vasculature in addition to comment on FT functions were given. At the end of the procedure, endometrial sample was taken from all cases.