How Common Are Adhesions After Hysterectomy?

Cervical canal adhesions refer to cervical canal stenosis or atresia due to mechanical adhesion of the cervical canal mucosa. Uterine cavity adhesion refers to the adhesion of part or all of the front and back walls of the uterine cavity so that the uterine cavity becomes narrow or disappears.

Basic Information

English name

metrosynizesis

Visiting department

Gynecology

Common causes

Female uterine cavity operation history, surgical inflammatory factors, human factors

Common symptoms

Abdominal pain, abnormal menstruation, abnormal pregnancy

Causes of uterine adhesions

1. Female uterine cavity operation history

Pregnancy-related uterine cavity surgery such as early pregnancy negative pressure suction surgery, mid-pregnancy forceps curettage and mid-pregnancy induction curettage, postpartum hemorrhage and curettage and natural abortion and so on. These may be because the endometrium basal layer of the pregnant uterus is relatively easy to be damaged, which causes the uterine walls to adhere to each other and form permanent adhesions.

2. Inflammatory factors of surgery

Intrauterine infection in women, endometritis of senile uterus after menopause, secondary infection after uterine cavity operation, infection during puerperium, secondary infection caused by IUD placement and so on.

3. Human factors

Artificially damaged the basal layer of women's endometrium, causing her to have intrauterine adhesions. For example: after endometrial electroresection, intrauterine microwave, cryotherapy, chemotherapy and local radiotherapy.

Clinical manifestations of uterine adhesions

Lower abdominal pain

If the patient's condition continues to worsen, there will be abdominal pain, mainly menstrual periods, and some even affect normal rest and sleep, which will greatly affect women's life and work. Generally, about one month after induced abortion or curettage, sudden lower abdominal cramping pain appears. Some patients have severe abdominal pain, restlessness, difficulty in movement, and even painful discharge and defecation.

2. Menstrual abnormalities

Amenorrhea may occur in patients with complete adhesion of the cervix, and those with partial adhesion of the cervix or destruction of the endometrium show less menstruation, but the menstrual cycle is normal. If it is caused by cervicitis or other inflammations, it will lead to amenorrhea in some patients, and some patients will have irregular menstruation, prolonged menstruation, dark menstrual blood and other abnormal phenomena.

3. Pregnancy abnormalities

Patients are prone to pregnancy failure, including early and second trimester miscarriage, premature birth, ectopic pregnancy, late abortion, intrauterine death and so on. Infertility is the most important symptom of the disease. The disease can cause the fertilized egg to implant improperly due to the destruction of the endometrium and the adhesion of the uterine cavity, and eventually lead to infertility.

Uterine adhesion test

1. When exploring the uterine cavity, the uterine cavity is narrow or inaccessible.

2. Uterine lipiodol angiography shows that the uterine cavity is only partially filled or not completely filled.

Uterine adhesion treatment

Hysteroscopy: The clinical application of hysteroscopy can not only judge the degree of adhesion, the type of adhesion, but also the toughness of adhesion. Membrane adhesion and fibrous muscle adhesion can be separated under hysteroscopy or surgically cut off; for connective tissue-like dense adhesion, electrosurgical separation is required under ultrasound monitoring, and intrauterine device is placed to prevent re-adhesion And given continuous administration of estrogen and progestin to promote endometrial growth. Make the patient recover from menstrual cramps, and some patients can get pregnant again.