Synechia in the uterine cavity treatment. Intrauterine synechia: a century later

The honeymoon trip is a thing of the past. Young spouses are working hard to conceive a baby. However, the desired does not come. The woman herself notices that the monthly periods have become scarce, sometimes they do not occur at all. What is the reason? There are many of them, but one of them may be such a pathology not known to a wide range of ladies as intrauterine synechia. However, it is much more common than it seems at first glance, and it greatly affects the fate of a woman. What is it, how does it manifest itself and is there a way to deal with this disease? Details in a new article on the MedAboutMe portal.

The word "sinechia" is practically unfamiliar to people far from medicine, but adhesions or scars can be called its synonyms. This is not entirely true, but now the main essence of this disease is becoming clear. In the cervix or its cavity, peculiar thin bridges appear that tighten the walls, preventing the normal patency of these hollow formations. Sometimes there are so many of them that they lead to complete obliteration of the uterine cavity and obstruction of the cervix.

Intrauterine synechia has another name - Asherman's syndrome. It was first described at the very end of the 19th century in women who had undergone curettage of the uterine cavity in the past. Then scientists and doctors from different countries the world began to examine women who had abortions, inflammatory diseases uterus, including postpartum and post-abortion endometritis, manual separation of the placenta after childbirth. In many of them, they found peculiar adhesions in the lumen of the cervical canal and, after the advent of x-ray methods of research, in the uterus itself.

Despite the fact that this problem has been known for a long time, it has not yet been solved. There is modern facilities helping women, but it is still too early to talk about the victory over Asherman's syndrome.

What causes the appearance of synechia

Asherman's syndrome never appears in a woman without, as they say, a burdened gynecological or obstetric past. It develops in women who began to have sex, had pregnancies ending in various ways, and underwent a variety of intrauterine interventions. In any case, the trigger for the development of this disease is an injury to the basal layer of the endometrium (the inner lining of the uterine cavity). The main causes of Asherman's syndrome are as follows:

An additional risk factor is the development of endometritis after transferring a condition from the list above. Isolated endometritis usually does not lead to the appearance of synechia, although it is extremely rare. An exception is the tuberculous inflammatory process in the uterine cavity, or the one that develops after radiation therapy for malignant tumors in gynecology.

A woman can independently suspect the appearance of intrauterine synechia. This disease is characterized by the following specific symptoms and pathological conditions.

Violation menstrual cycle. Menstruation lasts 1-2 days or disappears altogether, while a pregnancy test gives negative result. The reasons are that adhesions obturate the lumen of the uterine cavity or cervix and the menstrual can not come out. Sometimes it accumulates in the free parts of the organ, or expires back, getting into the abdominal cavity. These conditions are extremely serious and require immediate medical attention.
Secondary infertility. That is, the woman has already had pregnancies in the past, but at present all attempts to achieve this are not successful. The reason is that the sperm of even a healthy man cannot reach the egg due to adhesions blocking their path. Even if fertilization occurs, the embryo cannot reach the uterine cavity and implant.
Habitual miscarriage. Pregnancy has come, but adhesions tighten the walls of the uterus, interfering with the normal development of the embryo. Spontaneous termination occurs or pregnancy does not develop.

About 40% of pregnancies in women with intrauterine synechia end in miscarriage at early term, another 23% - premature birth. 12% have an ectopic pregnancy. About 30% of women give birth on time (moreover, here we are talking, as a rule, about women with adhesions only in the cervix), but almost always there are indications for caesarean section. Placenta accreta and placenta previa often develop (in 13% of women).

Thus, the presence of Asherman's syndrome greatly affects both the menstrual and reproductive spheres. In order for such a woman to give birth safely, she needs medical help.

Varieties of intrauterine synechia

Given that various conditions lead to the appearance of adhesions, the localization of the process in women may be different.

The most favorable prognosis can be called cases when synechia are located in the cervical region. In this case, of course, there may be violations of menstruation, sometimes until their complete cessation. However, if the conception and implantation of the embryo has occurred, the pregnancy develops normally.
Synechia in the uterine cavity can be different. In the mildest case, these are central adhesions that do not tighten the uterus and do not cause a violation of its patency. In more severe cases, the cavity may be partially obturated up to complete blockage.
Sometimes adhesions form both in the uterine cavity and in the cervix. The medical prognosis directly depends on the degree of obturation and the prevalence of the process.

The most informative way to identify the presence of intrauterine synechia is hysterosalpingography. A radiopaque solution is injected into the uterine cavity and fallopian tubes through the cervix, and in the pictures the doctor can well assess the patency of these organs. They also use magnetic resonance ultrasound procedure.

The presence of adhesions in the uterine cavity and cervix is an important reason for contacting a doctor for active treatment. However, the paradox is that any surgical removal and scraping them often leads to the formation of new ones. Synechia and scars remain after any operation, and in this case there is a risk that after this the volume of the lesion will become even larger.

They lead to partial or complete infection of the uterus, which is provoked by traumatic or infectious agents and neurovisceral factors.

The main reason for the appearance of synechia is mechanical trauma to the basal layer of the endometrium, which accompanies surgical abortions, miscarriages or childbirth.

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Causes of synechia:

The main reason for the formation of synechia are injuries of the basal layer of the endometrium, obtained by mechanical action. Most often, such violations are the result of curettage after childbirth and abortion. The most traumatic are the first four weeks after such procedures.

Also, the appearance of synechia in the uterus can be facilitated by other surgical interventions (metroplasty, myomectomy, diagnostic curettage of the mucosa) and intrauterine administration of medications, including contraceptives.

Acquired infection and inflammation are secondary factors.

The occurrence of intrauterine synechia is most susceptible to patients with missed pregnancy. Remains of placental tissue can cause fibroblast activation and promote collagen formation even before endometrial regeneration. With repeated miscarriages, the likelihood of developing synechia increases.

In women who have not been subjected to intrauterine manipulations in the past, the cause of synechia becomes chronic endometritis.

Synechia in the uterine cavity - symptoms

Basically, the symptoms depend on the degree of infection of the uterus. There is a certain classification of synechia that characterizes the disease depending on the degree of spread and the state of tightening of the uterus.

I degree - about 1/4 of the volume of the uterine cavity is occupied, the synechiae are thin, the mouths of the tubes and the bottom are free;

II degree - 1/4 - 3/4 of the volume of the uterine cavity is occupied, there is no adhesion of the walls, there are only adhesions, the mouths of the tubes and the bottom are not completely closed;

III degree - more than 3/4 of the volume of the uterine cavity is occupied.

The main symptoms are pain in the lower abdomen, which increase during menstruation. The nature of the secretions also changes, they become scarce and short-lived.

Pain sensations depend on the location of the synechiae. If the adhesions are located in the lower part of the uterus in the cervical canal, they interfere with the normal removal of blood and the feeling of pain is especially severe. Thus, the formation of hematometers and the complete cessation of menstruation are possible. When menstruation passes without problems, women experience almost no pain. The most severe consequences of synechia are infertility and miscarriage. Significant fusion of the uterine cavity prevents the movement of the sperm to the egg. Also, the affected endometrium does not allow the fertilized egg to attach to the wall of the uterus, as the mucous membrane is replaced by connective tissue.

Diagnosis of synechia in the uterine cavity is carried out with hysterosalpingography, hysteroscopy and ultrasound.

Intrauterine synechia: treatment

The most effective treatment for intrauterine synechia is surgical. But before the operation, medical preparation is necessary, aimed at creating a reversible atrophy of the endometrial tissue, which will provide optimal conditions for surgical intervention. Used for preoperative treatment hormonal preparations that inhibit the growth and maturation of the endometrium.

The surgical operation to remove intrauterine synechia is called hysteroresectoscopy. It is performed using a special device through the vagina. After surgery, the patient is prescribed antibiotic therapy. In addition, physiotherapy is shown, the purpose of which is to accelerate the healing process, increase the body's defenses, and also prevent adhesions or new intrauterine synechia from appearing. Treatment begins no later than one and a half days after the operation. For it, a constant or alternating magnetic field is used, as well as supertone frequency currents and a laser. A second course of physiotherapy treatment is prescribed immediately after the end of the first menstruation after the operation. The required number of courses is determined individually. Usually, you can conduct up to three courses, the interval between them should be at least 3 months.

If a woman of childbearing age has intrauterine synechia due to an inflammatory process, the patient is prescribed hormone replacement therapy after surgery, which will help restore the endometrium, begin to fully reject it during menstruation and prepare the uterus for future pregnancy. Rehabilitation treatment also involves the use of immunomodulators.

After surgical treatment The patient has been seen by a doctor for six months. If the patient's treatment was about infertility, then at this time ovulation is monitored, endometritis recovery is monitored. If the cause of infertility was exactly and only synechia in the uterine cavity, the woman should become pregnant.
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Intrauterine adhesions are called adhesions located inside the uterus. Other name this disease- Asherman's syndrome. The consequence of such changes is the infection of the uterus, which leads to infertility or spontaneous abortions.

What is it

Synechia is a pathological fusion of the surface of an organ or the adjacent surfaces of different organs. If they appear in the uterus, then its walls are soldered together and cause its deformation.

Synechiae are formed in the basal layer of the uterus. Its peculiarity is that it contains connective tissue fibers, due to which the mucous membrane is extensible and elastic.

If the patient has this pathology, this can lead to menstrual dysfunction and infertility. Even if pregnancy occurs, there is a high probability of losing a child.

Reasons for the appearance

In most women, adhesions in the uterus appear due to mechanical injuries in which the basal layer is affected. The epithelium of this layer of the uterus reacts to damage and tries to restore its integrity. It begins to grow, involving other fibers in this process. Because of this, strands are formed. Gradually, these formations "contract" the walls of the uterus, because of which it is deformed. In the most severe cases, the uterine cavity is completely closed.

The endometrium can be damaged:

during an abortion;
when scraping the uterus, if a woman has begun uterine bleeding or had polyps;
due to intrauterine contraceptives;
during operations that affect the uterine cavity.

If an infection joins the injury, the mucous layer is damaged even more. Contribute to the appearance of this disease genital tuberculosis, missed pregnancy and radiation therapy, carried out due to a tumor of the ovaries or uterus.

Symptoms

Symptoms of intrauterine synechia depend on the condition of the uterus and the degree of the disease. Many patients may develop hypomenstrual syndrome. With it, menstruation becomes not as plentiful as before, less long, sometimes it comes in the form of a daub, and in some it disappears altogether. If the endometrium in the upper layers is not affected, a pathological condition (hematomera) may develop, in which the outflow of menstrual blood is difficult. This creates favorable conditions for the development of inflammation and other complications. The patient complains of weakness, dizziness, may lose consciousness, later complaints of pain appear.

Kinds

There are several types of intrauterine synechia:

Lungs: fragile, easily dissected by a hysteroscope; derived from basal endometrial cells.
Medium: denser, they include muscle fibers and fibrous tissue; they are firmly soldered to the mucous membrane of the uterus and bleed when cut.
Heavy: the most dense, made of coarse connective tissue, difficult to dissect.

Degrees

Patients may have a different number of synechiae, different degrees of infection of the uterine cavity. This affects the course of the disease and treatment. There are 3 degrees of the disease:

The first one is the easiest. Adhesions occupy a small area of the mucosa (less than 25%), they are absent at the bottom of the uterus and at the mouth of the fallopian tubes. Formations are thin.
Second. The pathological process captured more than 25% of the uterus, but less than 75%. The adhesions partially overlap the bottom of the uterus and the mouths of its tubes, but the walls of the organ are free, do not stick together.
Third. Almost the entire endometrium (more than 75%) suffered from the adhesive process. The resulting synechiae are dense, they splice the walls of the uterus together.

Synechia and pregnancy

Intrauterine synechia and pregnancy are closely related. It is intrauterine synechia that is considered as the main cause of infertility. Because of them, menstruation may be absent, the body becomes unprepared for fertilization. But even if critical days arrive on time, there are difficulties with implantation gestational sac. It is useless for women with a similar diagnosis to do IVF, it will be ineffective.

If the patient is able to become pregnant, there is a high risk of losing a child (1/3 of patients with a similar diagnosis experience spontaneous miscarriages). Complications are also possible during pregnancy, during childbirth and in the postpartum period (premature birth, placental pathology, etc.). Therefore, women who dream of a child must first undergo a course of treatment, and only then plan a pregnancy.

Diagnostics

The doctor may suspect the presence of this pathology if the patient cannot become pregnant or menstrual function is disturbed after abortions, curettage, or other intrauterine manipulations. But he will not be able to immediately diagnose "intrauterine synechia", diagnostics are necessary. 2 examinations help to detect this disease:

Hysterosalpingography. This is an X-ray examination of the fallopian tubes and uterus using a contrast agent. Sometimes this study gives a false positive result if there are endometrial scraps, mucus and curvature in the uterus.
Hysteroscopy. A hysteroscope is inserted into the patient through the vagina, which helps the doctor to examine the uterine mucosa and see synechia. They appear as avascular strands of light shades of various lengths and densities.

Additional examinations are also possible: ultrasound of the small pelvis or hormonal tests. Moreover, ultrasound is almost useless; it can only be used to examine irregular contours of the mucous membrane.

Treatment

How to treat intrauterine synechia to get rid of them forever? There is only one method of treatment - mechanical dissection of synechiae. The easiest way to remove thin formations, the hysteroscope can easily cope with this. If they are denser and not easily removed, endoscopic scissors, forceps, laser, etc. are used. In order not to damage the uterus, the doctor controls the operation using ultrasound or laparoscopy.

After dissection, a hysteroscopic examination is necessary. It should show that there are no synechiae, the corners of the uterus are free, near which the fallopian tubes are located. This completes the initial stage of treatment, but with intrauterine synechia this is not enough, it is necessary to restore the work of the endometrium. Therefore, the patient needs cyclic hormonal therapy, which can last about 3-6 months.

If the disease is complicated by infection, antimicrobial therapy is prescribed. Treatment folk remedies with intrauterine synechia it is ineffective, because no herbs will help remove the adhesions formed in the uterus. But if desired, a woman, after consulting a doctor, can drink fortifying decoctions that will help her recover faster.

Important! After the treatment, the patient can quickly become pregnant. But doctors advise not to rush. If a woman wants her pregnancy and childbirth to proceed without complications, it is better to wait until the body recovers completely.

Prevention

Even after successful treatment, a relapse of the disease is possible; in 60% of patients, dense synechiae can form again. To exclude this, doctors recommend putting an intrauterine device at least for a month.

Prevention of this disease:

Refusal of abortions, use of contraceptives;
Timely treatment of genital infections;
Complete examination for menstrual irregularities.

Intrauterine synechia can appear in any woman due to damage to the endometrium of the uterus. Often this leads to infertility or causes miscarriages, early births, etc. This disease is treated, especially if you do not delay the visit to the doctor. The patient will eventually be able to become pregnant and give birth to a child. However, the management of pregnancy should be carried out by an experienced obstetrician-gynecologist, who will take into account all possible risks.

The honeymoon trip is a thing of the past. Young spouses are working hard to conceive a baby. However, the desired pregnancy does not occur. The woman herself notices that the monthly periods have become scarce, sometimes they do not occur at all. What is the reason? There are many of them, but one of them may be such a pathology not known to a wide range of ladies as intrauterine synechia. However, it is much more common than it seems at first glance, and it greatly affects the fate of a woman. What is it, how does it manifest itself and is there a way to deal with this disease? Details in a new article on the MedAboutMe portal.

What is intrauterine synechia

Intrauterine synechia has another name - Asherman's syndrome. It was first described at the very end of the 19th century in women who had undergone curettage of the uterine cavity in the past. Then scientists and doctors from around the world began to examine women who had had abortions, inflammatory diseases of the uterus, including postpartum and post-abortion endometritis, manual separation of the placenta after childbirth. In many of them, they found peculiar adhesions in the lumen of the cervical canal and, after the advent of x-ray methods of research, in the uterus itself.

Despite the fact that this problem has been known for a long time, it has not yet been solved. There are modern means of helping women, but it is too early to talk about victory over Asherman's syndrome.

What causes the appearance of synechia

surgical termination of pregnancy, curettage of the uterine cavity after childbirth, for diagnosis, regarding the presence of polyps, manual separation of the placenta after childbirth, setting an intrauterine device, operations on the uterus - removal of fibroids, polyps, conization of the cervix, etc., miscarriage.

How to suspect Asherman's syndrome

A woman can independently suspect the appearance of intrauterine synechia. This disease is characterized by the following specific symptoms and pathological conditions.

Violation of the menstrual cycle. Menstruation lasts 1-2 days or disappears altogether, while a pregnancy test gives a negative result. The reasons are that adhesions obturate the lumen of the uterine cavity or cervix and menstrual blood cannot come out. Sometimes it accumulates in the free parts of the organ, or expires back, getting into the abdominal cavity. These conditions are extremely serious and require immediate medical attention. Secondary infertility. That is, the woman has already had pregnancies in the past, but at present all attempts to achieve this are not successful. The reason is that the sperm of even a healthy man cannot reach the egg due to adhesions blocking their path. Even if fertilization occurs, the embryo cannot reach the uterine cavity and implant. Habitual miscarriage. Pregnancy has come, but adhesions tighten the walls of the uterus, interfering with the normal development of the embryo. Spontaneous termination occurs or pregnancy does not develop.

About 40% of pregnancies in women with intrauterine synechia end in early miscarriage, another 23% in premature birth. 12% have an ectopic pregnancy. About 30% of women give birth on time (moreover, here we are talking, as a rule, about women with adhesions only in the cervix), but almost always there are indications for a caesarean section. Placenta accreta and placenta previa often develop (in 13% of women).

Thus, the presence of Asherman's syndrome greatly affects both the menstrual and reproductive spheres. In order for such a woman to give birth safely, she needs medical help.

Varieties of intrauterine synechia

Given that various conditions lead to the appearance of adhesions, the localization of the process in women may be different.

The most favorable prognosis can be called cases when synechia are located in the cervical region. In this case, of course, there may be violations of menstruation, sometimes until their complete cessation. However, if the conception and implantation of the embryo has occurred, the pregnancy develops normally. Synechia in the uterine cavity can be different. In the mildest case, these are central adhesions that do not tighten the uterus and do not cause a violation of its patency. In more severe cases, the cavity may be partially obturated up to complete blockage. Sometimes adhesions form both in the uterine cavity and in the cervix. The medical prognosis directly depends on the degree of obturation and the prevalence of the process. How Is Asherman's Syndrome Diagnosed and Treated?

The presence of adhesions in the uterine cavity and cervix is an important reason for contacting a doctor for active treatment. However, the paradox lies in the fact that any surgical removal of them and curettage often leads to the formation of new ones. Synechia and scars remain after any operation, and in this case there is a risk that after this the volume of the lesion will become even larger.

Therefore leading surgical method treatment today is the dissection of adhesions with scissors under the control of hysteroscopy. This method does not require large incisions and is not as traumatic as those used in the past.

However, the main difficulty of this problem lies not only in removing those adhesions that already exist, but also in preventing the formation of new ones. For this, intrauterine hormonal agents (spirals) were previously used, but their effectiveness was not impressive, moreover, they themselves are an additional risk factor for the appearance of new adhesions.

To date, for the prevention of relapse, individual oral hormonal agents are used, the introduction of gels containing hyaluronic acid into the lumen of the cervix and uterine cavity. The latter show very good results, making it possible for women who had previously had a very sad obstetric experience to become pregnant and give birth, to restore menstrual function and a full life.

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Intrauterine synechia (Asherman's syndrome) - intrauterine adhesions between individual sections of the uterine mucosa, leading to complete or partial obliteration (infection) of the uterine cavity. In the presence of synechia, the normal endometrium may undergo atrophic changes. Intrauterine synechia lead to a disorder of menstrual function, create mechanical obstacles to the advancement of spermatozoa, and worsen the conditions for implantation of the fetal egg.

The presence of this syndrome can interfere with in vitro fertilization. From here follow the main manifestations of Asherman's syndrome - hypomenorrhea (scanty menstruation), secondary amenorrhea (cessation of menstruation), algodismenorrhea (painful menstruation), spontaneous abortions, miscarriage, infertility, sometimes hematometra develops (accumulation of blood in the uterine cavity).
To confirm the diagnosis and in order to establish the exact localization of adhesions, ultrasound, hydrosonography, and diagnostic hysteroscopy are prescribed.

Reasons for the formation of synechia

The most common cause of Asherman's syndrome is previous mechanical trauma to the basal endometrium. Injury to the endometrium can occur as a result of surgical termination of pregnancy, the use of intrauterine contraceptives, diagnostic curettage of the cavity, operations in the uterine cavity (myomectomy, metroplasty). Damage to the endometrium can be aggravated by the addition of infection with the development of endometritis. The development of intrauterine adhesions can be promoted by genital tuberculosis, intrauterine instillations, radiation therapy for tumors of the uterus and ovaries. Often, the formation of intrauterine synechia occurs against the background of a previous missed pregnancy.

Classification of intrauterine adhesions

The main classification criterion is how closed the organ cavity is, how much it was affected pathological changes. It is customary to distinguish 3 degrees of intrauterine synechia:

First. The mildest form, in which less than ¼ of the uterine cavity is involved, the adhesions are thin, the orifices of the fallopian tubes are free.
Second. It is diagnosed if 14 to 34 uterine cavities are involved, and the orifices of the tubes are blocked, although not completely.
Third. More than 34 uterine cavities are involved, i.e. the uterine cavity is almost completely closed.

Surgery

The only one effective method treatment - dissection of intrauterine synechia. The operation is carried out under the control of a hysteroscope: this is a tube with a light source, a camera and a surgical instrument that allows you to display an image of the uterine cavity on the screen. It is preferable to use mechanical separation of synechiae, but also a hysteroresectoscope - "electroknife" may be required for the intervention. The operation is safe, healthy tissues are almost not damaged, therefore recovery period after it is short.

To prevent perforation of the organ, the dissection of intrauterine synechia is carried out under the control of ultrasound equipment. And in order to prevent relapse, after the intervention, a course is prescribed hormone therapy or an IUD is introduced for 1-2 months. The prognosis is usually favorable, but it depends on the extent of the lesion. The lighter the degree, the easier the operation and the lower the risk of complications. After dissection of synechiae of the 2nd and 3rd degree, after 2-3 months, it is desirable to perform a control hysteroscopy. You can plan pregnancy after the restoration of menstrual function (usually after 3-4 months). But even with successful therapy, women who have a history of uterine adhesions require special attention from obstetrician-gynecologists during pregnancy.

The REMEDI Reproductive Health Clinic offers a first-class service. We diagnose and treat gynecological diseases, perform surgeries of any complexity.

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