Intrauterine Adhesions

What are intrauterine adhesions?

Scars in the womb are called intrauterine adhesions. These can develop after certain procedures like dilation and curettage (D&C), a procedure where the inner lining of the womb is scraped. Curettage is used to induce abortion, remove placental remnants after child birth or pregnancy loss, or for the removal of uterine fibroids or myomas. Intrauterine adhesions can lead to bleeding and infertility.

Symptoms

• Abnormal vaginal bleeding
• Pelvic pain
• Recurrent pregnancy loss

Diagnosis and Treatment of Intrauterine Adhesions

Diagnosing uterine adhesions typically involves imaging techniques. Hysteroscopy is considered the most accurate method, allowing doctors to directly visualize the inside of the uterus. Other diagnostic tools include hysterosalpingography (HSG) and saline sonohysterogram (SHG), which can reveal adhesions as "filling defects" where fluid doesn't flow freely.

The primary treatment for intrauterine adhesions is hysteroscopic adhesiolysis. In this procedure, a thin, lighted instrument is inserted through the cervix to remove the scar tissue. For severe cases, multiple surgeries may be necessary. After the procedure, doctors often place a small balloon or catheter in the uterus to keep the walls separated during healing. This is typically combined with hormone therapy to promote endometrial regrowth.

While treatment can be effective, the recurrence rate of adhesions can be high, especially in severe cases. However, with proper treatment, many women with mild to moderate adhesions can achieve successful pregnancies. It's important to note that even after treatment, women may face a higher risk of pregnancy complications and should be closely monitored.

Treatment

You should discuss your symptoms with your primary care physician or OB/GYN. They will likely perform further testing like a hormone test or a hysteroscopy. The adhesions can be removed through surgery, and this treatment may be followed by estrogen therapy to reduce the chance of the scar tissue returning.