Are endometrial adhesions serious?

The health of the endometrium has a great impact on women's health and fertility. However, in real life, many people have certain health problems with their endometrium. For example, endometrial adhesions is a very common endometrial disease. The severity of this disease is also high. Next, I will introduce you to some relevant knowledge about endometrial adhesions!

1. Causes

Endometrial damage is a necessary condition for intrauterine adhesions, and its causes are miscarriage, infection and iatrogenic injury.

(1) During pregnancy, the uterus becomes fragile, and the endometrium and the underlying layer are more easily injured; after pregnancy surgery (including abortion, curettage, etc.), the decrease in estrogen levels affects endometrial hyperplasia. Uterine injury during pregnancy (accounting for 90%), including abortion (induced abortion, incomplete/missed abortion), postpartum hemorrhage, retained placenta, cesarean section and gestational trophoblastic disease trauma.

(2) Intrauterine adhesions may also occur during other non-pregnancy periods, such as during diagnostic curettage. Occurs during the non-pregnancy period: after curettage, myomectomy, cervical biopsy or polypectomy, and after radium irradiation. Patients who have undergone hysteroscopic surgery, such as mediastinectomy, submucosal myomectomy, bilateral uterine artery embolization, and uterine artery ligation for postpartum hemorrhage.

(3) Infection: The most common infection is endometrial tuberculosis. Chronic or subacute endometritis may also lead to intrauterine adhesions.

(4) Others: Related to abnormal development of the Müllerian duct, especially septate uterus.

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

II. Treatment

Hysteroscopy is currently an effective means of treating intrauterine adhesions and is also the gold standard for diagnosis. It is a invasive surgery that reduces complications. Complications during hysteroscopy may include perforation, bleeding, shock, and even death. The surgery requires evaluation of the thickness, type, and blood flow of the endometrium, and assessment of the entire length of the cervical canal, internal cervical os, uterine cavity, and fallopian tubes. If necessary, perform laparoscopic curettage.

1. Hysteroscopic treatment

Mild membranous adhesions can be bluntly separated (pushing, pushing, tearing) with the tip of the hysteroscope; dense adhesions can be separated with micro scissors, forceps, needle electrode electroresection or laser surgery; severe adhesions: because perforation and bleeding are prone to occur at the edges or fibromuscular adhesions, they are usually performed under laparoscopy or ultrasound monitoring.

2. Laparotomy

Transabdominal hysterotomy for the treatment of intrauterine adhesions is rarely used now unless hysteroscopic separation is difficult.

Prevention of intrauterine adhesions after surgery: Since intrauterine adhesions are prone to recurrence, especially severe ones, the recurrence rate can be as high as 62.5%, and repeated surgery and separation effect evaluation are often required. Therefore, preventing recurrence is the key to successful treatment. ①Intrauterine contraceptive device placement: Routine intrauterine contraceptive device placement after surgery is a widely used and effective method to prevent adhesions, and is generally placed for at least 3 months. ② Placement of balloon catheter: The water-filled balloon acts as a barrier in the uterine cavity, effectively separating the front and back, upper and lower, and left and right side walls of the uterus, and effectively preventing re-adhesion of the uterine cavity. ③Sodium hyaluronate: Sodium hyaluronate has a mechanical barrier effect and reduces the occurrence of intrauterine adhesions. ④ Medical chitosan and amniotic membrane transplantation. ⑥Drugs: mainly to continuously stimulate endometrial growth such as estrogen-progesterone cyclical therapy, vasodilators, growth hormone, etc.

Prognosis

Intrauterine adhesions are a common disease throughout the world. Hysteroscopic treatment is currently an effective treatment, but the treatment of severe adhesions is still difficult. After successful separation, attention should be paid to postoperative care to avoid re-adhesion, which can generally be improved.