A new systematic review and network meta-analysis has evaluated the effectiveness of various postoperative interventions for preventing the recurrence of intrauterine adhesions, known as IUA, following hysteroscopic adhesiolysis. Published in the Archives of Gynecology and Obstetrics, the study aims to comprehensively analyze how different treatments compare in reducing the likelihood of adhesion reformation. The research focuses on interventions administered after transcervical resection of adhesions.
The study team conducted a literature search across PubMed, Cochrane, and Embase databases to identify eligible studies published prior to March 11, 2026. Only randomized controlled trials involving interventions for IUA prevention after transcervical resection of adhesions were included in the analysis. Outcomes included IUA recurrence rate, AFS score reduction, AFS score, and clinical pregnancy rate.
The analysis included twenty-six studies encompassing a total of 3,040 patients. The interventions compared included intrauterine estrogen-releasing systems, intrauterine devices (IUDs), platelet-rich fibrin (PRF), platelet-rich plasma (PRP), and balloon catheters, often used in combination.
Regarding the prevention of adhesion recurrence, the intrauterine estrogen-releasing system demonstrated the highest probability of being the best intervention, with a Surface Under the Cumulative Ranking Curve (SUCRA) value of 95.40%. This system was found to be superior to the standard IUD, with an odds ratio of 5.35 for the IUD versus the system, indicating a significantly higher risk of recurrence with the IUD alone. The 95% confidence interval for this comparison was 1.08 to 26.50.
In terms of clinical pregnancy rates, platelet-rich fibrin (PRF) showed the highest probability of being the best intervention, with a SUCRA value of 85.42%. PRF was superior to both the control group and the IUD. The odds ratio for the control group versus PRF was 0.20, with a 95% confidence interval of 0.05 to 0.83, while the odds ratio for the IUD versus PRF was 0.16, with a 95% confidence interval of 0.03 to 0.80.
IUD + balloon ranked highest for AFS reduction, with a SUCRA value of 98.68%. Conversely, the combination of platelet-rich plasma (PRP) and a balloon catheter ranked highest for the absolute AFS score, with a SUCRA value of 85.82%.
Despite the promising results for specific interventions, the study observed substantial heterogeneity in the data for both AFS score reduction and absolute AFS score. The I2 was 90% for AFS reduction and 99.6% for AFS score. This substantial heterogeneity warrants cautious interpretation. No publication bias was detected.
The authors conclude that while the intrauterine estrogen-releasing system and the IUD plus balloon combination showed promising results for preventing IUA recurrence, and PRF showed potential efficacy for improving postoperative pregnancy rates, the findings should be considered exploratory. Given the substantial heterogeneity and the limited amount of evidence available, these results should be interpreted with caution.
Subject of Research: Comparative effectiveness of postoperative interventions for preventing intrauterine adhesion recurrence
Article Title: Prevention of recurrence of intrauterine adhesions after hysteroscopic adhesiolysis: a systematic review and network meta-analysis of randomized controlled trials
Article References: Song, W., Ma, Y., Xiong, Q., Hou, Q., & Xin, L. (2026). Prevention of recurrence of intrauterine adhesions after hysteroscopic adhesiolysis: a systematic review and network meta-analysis of randomized controlled trials. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-026-08544-7
Image Credits: AI Generated
DOI: 10.1007/s00404-026-08544-7
Keywords: intrauterine adhesions, hysteroscopic adhesiolysis, network meta-analysis, randomized controlled trials, platelet-rich fibrin, intrauterine device, estrogen-releasing system, reproductive health, clinical pregnancy rate, AFS score, Prevention, recurrence
News Source: Ophelia Keating. (November 10, 2026). Network Meta-Analysis Compares Intrauterine Adhesion Prevention Methods. Scienmag.
