Limitations of Estrogen–Progestogen Therapy for Vascular Retained Products of Conception: Insights From Two Treatment‐Resistant Cases

ABSTRACT Objective To elucidate clinical scenarios in which estrogen‐progestogen therapy (EPT) is ineffective for the management of vascular retained products of conception (RPOC). Case Report In Case 1, a patient with vascular RPOC following a missed miscarriage underwent two cycles of EPT, which failed to resolve the lesion. Subsequent imaging identified an angular pregnancy within a septate uterus. In Case 2, EPT was initiated for a vascular intrauterine lesion in the absence of an endometrial echo complex post‐curettage. Despite 1 month of therapy, there was no reduction in vascularity. Discontinuation of EPT precipitated profuse hemorrhage, necessitating hemostasis with a Foley catheter. Conclusion EPT may prove ineffective when implantation occurs at anatomically aberrant sites or in the context of an insufficient endometrial lining. These situations may require alternative therapeutic approaches.