Best treatment for uterine adhesions

Intrauterine adhesions (IUA), also known as Asheman's syndrome, are caused by trauma to the pregnant or non-pregnant uterus, which causes damage to the dermis of the uterine wall, resulting in partial or complete blockage of the uterine cavity and causing irregular menstruation, infertility or repeated miscarriages. Its essence is the endometrial fibrosis process.

Causes of intrauterine adhesions

Damage to the uterine wall is a necessary criterion for intrauterine adhesions, the causes of which are miscarriage, infection and iatrogenic injury.

(1) During pregnancy, the uterus becomes more sensitive, and the endometrium and the bottom layer are more easily injured; after pregnancy surgery (including abortion, curettage, etc.), the level of estrogen decreases, affecting endometrial hyperplasia. Uterine damage during pregnancy (accounting for 90%), including miscarriage (abortion, incomplete/missed abortion), postpartum hemorrhage, placental retention, cesarean section and gestational trophoblastic disease trauma.

(2) Intrauterine adhesions can also occur during other non-pregnancy periods, such as during a curettage. Occurs during the non-pregnancy period: after curettage, uterine fibroid removal surgery, cervical puncture biopsy or cyst removal, and after direct radium irradiation. Patients after hysteroscopic surgery, such as septum removal, submucosal uterine myomectomy, bilateral uterine artery embolization, and uterine artery ligation for postpartum hemorrhage.

(3) Infection: The most common infection is uterine wall tuberculosis. Chronic or acute endometritis may also cause intrauterine adhesions.

(4) Others: Abnormalities in the development of the Müllerian ducts, especially uterine septum.

(5) Genetic factors: The disease is related to genetic factors.

Clinical symptoms of intrauterine adhesions

There are usually no typical symptoms of intrauterine adhesions, the main symptoms being changes in menstrual periods, scanty menstruation, even amenorrhea, and dysmenorrhea. Some patients also suffer from infertility or repeated miscarriage. Most patients discover this during medical examinations. Intrauterine adhesions are divided into five degrees according to the level of adhesion.

Grade I: There are several fibrous adhesions in the uterine cavity, and the uterine horns and fallopian tube openings on both sides are normal.

Grade II: There are high-density fiber bundles adhesions between the anterior, posterior, left and right walls of the uterus, and the openings of the uterine horns and fallopian tubes on both sides can be seen.

Grade III: Fibrous adhesions cause locking of part of the uterine cavity and one side of the uterine corner.

Grade IV: Fibrous adhesions cause locking of part of the uterine cavity and both uterine corners.

VA: The adhesion bands become scarred, causing the uterine cavity to become extremely deformed and narrow.

Ⅴb adhesions and scarring lead to complete regression within the uterine cavity.

Adhesion classification: Blood pressure based on location: simple cervical adhesion; cervical and uterine cavity adhesion; simple uterine cavity adhesion; Blood based on adhesion site: central type; peripheral type; complex type; Supplementary based on adhesion range: mild 1/4 intrauterine cavity; mild to moderate 1/4 intrauterine cavity, 1/2 intrauterine cavity; moderate to severe 1/2 intrauterine cavity.