Intrauterine adhesions

• Pathophysiology/Etiology
  • Acquired condition characterized by intrauterine adhesions (synechiae) and/or fibrosis, which can obliterate the uterine cavity.
  • Most common cause: Uterine instrumentation, especially dilation and curettage (D&C), often after pregnancy (e.g., retained products of conception, elective abortion). The risk increases with repeated procedures.
  • Mechanism: Trauma to the basal layer of the endometrium leads to abnormal healing and scar tissue formation, bridging uterine walls.
  • Other causes: Myomectomy, endometritis (especially tuberculous), or other uterine surgeries.
• Clinical features
  • Usually asymptomatic
  • Abnormal uterine bleeding
  • Secondary amenorrhea
  • Infertility
  • Recurrent pregnancy loss
  • Periodic abdominal pain
• Diagnostics
  • Negative progesterone withdrawal test: No bleeding after progesterone cessation suggests blockage of the outflow tract.
  • Confirmatory test: hysteroscopy to directly visualize adhesions
  • Hysterosalpingography: honeycomb appearance of the uterus
• Treatment
  • Hysteroscopic resection of the adhesions
  • Treatment is only indicated if patients are symptomatic.