How are synechiae formed?
The endometrium consists of two layers: the functional one, which is shed every menstruation, and the basal one, from which it is then restored. The basal layer is the growth zone, and it is damage to it that leads to the problem.
When the basal layer is injured - usually during curettage, especially due to pregnancy or inflammation - connective tissue forms in its place. The walls of the uterus, in contact, grow together, and the cavity is partially or completely obliterated.
- Curettage of the uterine cavity, especially after childbirth, abortion or missed abortion, is the main reason
- Repeated curettages significantly increase the risk
- Chronic endometritis
- Complicated childbirth and postpartum interventions
- Surgeries on the uterus: myomectomy with opening of the cavity, metroplasty
- Caesarean section
- Tuberculosis of the genital organs is a rare but serious cause
- Intrauterine device due to inflammation
Symptoms
- A sharp decrease in the volume of menstruation after the intervention
- Complete absence of menstruation
- Painful sensations in the lower abdomen on the days of expected menstruation in the absence of discharge - the blood does not find a way out
- Infertility
- Repeated early miscarriages
- Implantation failures during IVF
- Thin endometrium according to ultrasound, not growing during the cycle
- Sometimes - absence of symptoms with small adhesions
A key clue for the woman herself is a “before and after” comparison. If, after intrauterine intervention, menstruation has become noticeably scarcer or disappeared, this is a reason to consult a doctor rather than wait for the cycle to “restore itself.”
Diagnostics
- Hysteroscopy is the gold standard: allows you to see adhesions, assess their density, extent and condition of the endometrium
- Ultrasound of the pelvic organs - thin, uneven endometrium, sometimes accumulation of blood above the level of the fusion
- Hysterosonography with contrast - assessment of the shape of the uterine cavity
- Hysterosalpingography - cavity filling defects
- Pipelle biopsy of the endometrium - assessing the condition of the mucosa and identifying chronic endometritis
- Hormonal examination - to exclude other reasons for the absence of menstruation
- Testing for tuberculosis if suspected
The peculiarity of this diagnosis is that both ultrasound and hysterosalpingography provide only indirect data. The prevalence of adhesions and, no less important, the preservation of the endometrium can be reliably assessed only by direct examination during hysteroscopy.
Treatment
- Hysteroscopic division of synechiae under visual control is the main method
- The most gentle technique while preserving the remaining endometrium
- Measures to prevent re-union after surgery: insertion of an intrauterine device, catheter or anti-adhesion gel
- Hormonal therapy with estrogen to stimulate endometrial growth after surgery
- Treatment of concomitant chronic endometritis
- Control hysteroscopy to evaluate the result and separate newly formed adhesions
- Sometimes several stages of treatment are required
- Planning pregnancy after restoration of the cavity and endometrium
- IVF for persistent endometrial problems
- Surrogacy - in severe cases with complete loss of endometrial function
Prevention is the most important
- Refusal of unreasonable scrapings
- Medical termination of pregnancy and medical emptying of the uterus during a missed miscarriage instead of curettage, when possible
- Targeted hysteroscopic removal of polyps instead of blind curettage
- Using vacuum aspiration instead of curettage
- Examination and treatment of infections before intrauterine interventions
- Complete treatment of postpartum and post-abortion endometritis
- Reliable contraception to prevent abortions
- Observation after any intrauterine intervention with assessment of the nature of menstruation
Where is treatment in Tashkent
A hysteroscopic stand and a surgeon skilled in the technique of carefully dividing adhesions while preserving the endometrium are required.
In Tashkent, diagnostic and operative hysteroscopy for synechiae of the uterine cavity is performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If, after curettage, menstruation becomes significantly scarcer or stops, do not wait: the earlier hysteroscopy is performed, the greater the chance of preserving the remaining endometrium. Clinic contacts are below on the page.
