The standard method in the treatment of intrauterine adhesions (Asherman Syndrome) is the Hysteroscopy with Adhesiolysis procedure performed without making an incision in the abdomen.
✓What causes intrauterine adhesions?
The most common causes of intrauterine adhesions are curettage procedures performed under improper conditions, removal of fibroids, double uterus surgeries, radiation therapy, and intrauterine tuberculosis (TB) infections.
✓Symptoms of intrauterine adhesions
Women with intrauterine adhesions may experience irregular menstruation, infertility, recurrent miscarriages, slow fetal development during pregnancy, and placental abnormalities. Menstrual bleeding may decrease or individuals may have no menstruation at all. However, menstrual bleeding may also be normal. In individuals with infertility or recurrent miscarriage, it is important to evaluate this condition with consideration.
✓Intrauterine adhesions seen in young women
In young women with congenital uterine abnormalities, intrauterine adhesions can occur following surgeries performed to correct uterine abnormalities. The presence of a septum (septate uterus) in the uterus is a congenital condition. This septum manifests itself with a tissue called a septum that divides the inner lining of the uterus. The septum in question may be short or may divide the entire inner lining of the uterus in two. In some cases, a septum dividing the vagina in two may also be observed. In these individuals, cutting the septum with Hysteroscopy may be recommended. Additionally, adhesions may form in the inner lining of the uterus due to uterine tuberculosis.
✓Intrauterine adhesion surgery
The 'Hysteroscopy' method is frequently used in the treatment of intrauterine adhesions. In this method, just as in standard gynecological examination, a special optical instrument called a hysteroscope is inserted through the vagina and cervix to examine the inside of the uterus. The captured image is viewed on a screen through an optical-camera system while the surgery is performed. There is no incision in the patient's abdomen. Hysteroscopy surgery is compared to gastroscopy or colonoscopy because the operation is performed from inside with camera assistance. The operation takes approximately 30-60 minutes.
FOR DETAILS PLEASE REFER TO THE HYSTEROSCOPY TREATMENT PAGE.
✓Success Rate and Risks in Intrauterine Adhesion Surgery
Success following intrauterine adhesion surgery is related to the degree/extent of adhesions and the surgeon's experience. The denser and more extensive the adhesions (the larger portion of the uterine cavity they cover), the higher the likelihood of treatment failure.
In cases of dense/extensive adhesions, sometimes more than one hysteroscopic intervention may be needed. In cases with dense/extensive adhesions, after Hysteroscopy, a balloon (made from a urinary catheter) may be placed in the uterus for a few days to prevent adhesions from reforming. However, it has not been definitively shown that placing such a balloon prevents the recurrence of intrauterine adhesions.
Although oral estrogen hormone therapy may be used for a short period after the procedure in cases of dense/extensive adhesions, its benefit is debatable. In cases with dense/extensive adhesions, generally after the first menstruation, we recommend vaginal ultrasonography at an appropriate time (on days 10-14 of the menstrual cycle) and often repeated Hysteroscopy.
Another difficulty encountered in cases with intrauterine adhesions is, unfortunately, the thinness of the inner lining of the uterus. This condition, also called endometrial atrophy, most often occurs in cases with dense/extensive adhesions. There is no effective treatment.
In IVF Treatment (In Vitro Fertilization) applications, the goal on the day of egg retrieval is for the inner lining of the uterus to have a double wall thickness of over 7 mm. If below 7 mm, it is called inner lining thinness (endometrial atrophy). In inner lining thinness, live birth rates decrease in IVF Treatment. Particularly in severe cases below 4.5-5 mm, live birth rates decrease significantly.
What Awaits Patients After Uterine Adhesion Surgery?
Uterine adhesion surgery may take 10-20 minutes depending on the severity of the adhesions.
Hospitalization is not required after the operation.
There may be light vaginal bleeding for approximately 3-4 days and some groin pain. However, there will be no discomfort beyond that.
To prevent infection and pain, it is recommended to avoid sexual intercourse for 7-10 days after the operation.
In women with severe adhesions, multiple Hysteroscopy procedures are often necessary.
In women where the uterine cavity has been opened to acceptable dimensions or fully opened, if the tube outlets are also open and inner wall thickness has not developed poorly, the chance of natural pregnancy is high.
After adhesion release, even if the uterine cavity has been significantly created, in women where tube outlets cannot be seen, IVF Treatment (In Vitro Fertilization) may be necessary.
Can Pregnancy Occur with Uterine Adhesions?
Conception may be problematic in proportion to the severity of uterine adhesions. Particularly in the presence of severe uterine adhesions, if there is adhesion at the point where the tubes open into the uterus, and additionally if there is a thinness problem in the uterine inner wall, becoming pregnant may be difficult. However, in the presence of mild adhesions in a single area, natural pregnancy is certainly possible.
How Long Does Uterine Adhesion Surgery Take?
Uterine adhesion surgery is performed as Hysteroscopy. Through the vaginal route, access to the inside of the uterus is gained via the natural opening at the cervix, and with the camera at the tip of the device, the inside of the uterus is visualized and adhesions can be opened with scissors or electrical energy.
Hysteroscopic uterine adhesion correction surgeries take approximately 10-20 minutes depending on the severity and extent of the adhesions.
Does Uterine Adhesion Cause Pain?
Generally, in the presence of uterine adhesions, women do not experience pain complaints. The most prominent finding is a decrease in menstrual amount and duration. However, particularly in adhesions developing at the cervix that prevent menstrual blood from flowing outward, severe groin pain may be felt during menstrual periods.
What Happens if Uterine Adhesions Are Not Treated?
In a woman who does not desire children, if there is no pain complaint and there is no adhesion that would prevent menstrual blood from flowing outward, intervention would not be necessary. However, in a woman who desires children, the removal of uterine adhesions is important for the ability to conceive and to prevent complications during pregnancy.
Are Adhesions Visible on Uterine Film?
Uterine tube film (HSG) is an imaging method that allows visualization of the inside of the uterus and tubes using an opaque substance administered through the cervix. Not every uterine adhesion can be understood with HSG. However, in severe and extensive adhesions, it may show a filling defect appearance within the uterus.
Do Adhesions in the Uterus Prevent Pregnancy?
Uterine adhesions are classified as mild, moderate, and severe depending on their location and extent within the uterus. If uterine adhesions are severe and extensive, or if they cause adhesions in the areas where the tubes open into the uterus, and additionally if there is thinness in the uterine inner wall thickness, they may prevent pregnancy.
Are Uterine Adhesions Visible on Ultrasound?
Uterine adhesions cannot always be understood with ultrasound. However, in severe cases, it may show irregularity in the appearance of the uterine inner wall or thinness in the uterine inner wall thickness. Additionally, patients most often also report a decrease in menstrual amount and duration.