Conclusion
The application of LNG-IUD is superior to hysteroscopic niche resection in the treatment of postmenstrual spotting in women with niche in the uterine CS scar and with lower direct medical costs. Therefore, this therapy should be offered as a first line therapy in women with a niche and postmenstrual spotting without the desire to conceive within one year. The effect of LNG-IUD increased over time during the first year while the optimal effect of a hysteroscopic niche resection is reached after 3 months. Proper counseling of patients receiving LNG-IUD prevents unneeded premature removal of the IUD.