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How Long Does it Take Uterine Scar(s) to Heal?
Published in John C. Petrozza, Uterine Fibroids, 2020
Intrauterine adhesions, also known as Asherman's syndrome, are defined as the presence of adhesions inside the uterine cavity and/or endocervix. Clinical manifestations include amenorrhea, hypomenorrhea, recurrent pregnancy loss, infertility and abnormal placentation. Conforti et al. reviewed the risk factors associated with Asherman's syndrome and identified curettage after miscarriage to have the highest incidence of Asherman's syndrome [25]. Extrauterine adhesions following abdominal myomectomies may similarly cause problems with fertility as well as pain. There are many anti-adhesion adjuvants but there is no one accepted standard of care, and careful surgical technique is highly recommended.
Principles of Pathophysiology of Infertility Assessment and Treatment*
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
Intrauterine adhesions (Asherman’s syndrome) may be a cause of infertility. It is generally accompanied by menstrual disorders, mainly amenorrhea or hypomenorrhea. The cause of infertility is uncertain. It may be due to a mechanical obstruction of the cervical canal and/or uterine cavity, impeding sperm migration or implantation. Adhesions also may cause defective endometrial function, an unstable endometrial environment not suitable to nidation of the blastocyst. Diagnosis and location of intrauterine adhesions are based essentially on hysterography and hysteroscopy. The treatment consists of surgically removing the adhesions and at the same time preventing formation of new ones by immediate insertion of an intrauterine device (IUD) combined with estrogen therapy.
Medical treatment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
The levonorgestrel-releasing intrauterine system (Mirena® IUS) significantly reduces menstrual blood flow and dysmenorrhoea in women with endometriosis13,14. The results of a small observational study demonstrated few side-effects and high satisfaction. Twenty women with recurrent moderate or severe dysmenorrhoea after conservative surgery for endometriosis had a levonorgestrel-releasing intrauterine system inserted14. Fifteen out of the 20 women had significantly reduced menstrual pain and amenorrhoea or hypomenorrhoea. Three were dissatisfied, and two were uncertain about whether the device had improved their symptoms.
Clinical efficacy of myometrial and endometrial microwave ablation in the treatment of patients with adenomyosis who had anemia
Published in International Journal of Hyperthermia, 2022
Zuolin Li, Xiaolian Li, Min Lin, Sihua Qiu, Liangqin Wang, Liping Lai, Xuefen Luo, Zunyu Mo, Gang Dong, Guorong Lyu, Shuiping Li
Postoperative adverse events and complications included abnormal vaginal discharge, pain, fever, nausea, vomiting, hypomenorrhea, transient amenorrhea, and pelvic infections. However, no severe complications were reported, such as uterine perforation, bowel, or bladder injury. The incidence of adverse events was 68.8%, 12.5%, and 4.7% in SIR A, B, and C, respectively. Both SIR C were pelvic infections with long vaginal discharge (more than 20 days). The patient experienced postoperative pain, which resolved spontaneously within 24 h. In addition, postoperative vaginal fluid discharge mostly appeared pale pink or brown and lasted 0–60 days. The vaginal discharge in the MWA group disappeared within 1 week, whereas the vaginal discharge in the MEWA group lasted longer, mostly 2–4 weeks. The patients experienced low fever, which resolved spontaneously after 1 − 2 days of monitoring with oral medication. Up to 1 year postoperatively, five patients in the MEWA group had transient postoperative amenorrhea, which was resolved a few months later. Moreover, one patient developed intrauterine adhesions and consequent amenorrhea postoperatively, which was managed with lysis under hysteroscopy. In the two groups, 10 cases of hypomenorrhea were recorded.
Early versus late hysteroscopic resection after high-intensity focused ultrasound for retained placenta accreta
Published in International Journal of Hyperthermia, 2021
Sili He, Min Xue, Jianfa Jiang
During the follow-up, 72.5% of the patients in the early group had normal menstrual bleeding, while 82.6% of the patients in the late group recovered normal menstrual cycles (Table 4). In the early group, 11 patients complained of hypomenorrhea, and 7 of them received hysteroscopy and were diagnosed with intrauterine adhesions (IUA). Three of these seven patients were diagnosed with severe adhesions and the other four had moderate adhesion according to the AFS score [8]. In the late group, four patients complained of hypomenorrhea, and two of them received hysteroscopy. One of them was diagnosed with severe adhesion and the other with mild adhesion. In the early group, 11 patients desired future pregnancy and 5 patients became pregnant, resulting in 3 live births, 1 miscarriage, and 1 abortion. In the late group, 8 patients desired future pregnancy and 6 patients became pregnant, resulting in 3 live births, 1 miscarriage, 1 abortion, and 1 ectopic pregnancy. There was no difference in menstrual recovery and pregnancy outcome between the two groups (p = .36 and p = .82, respectively).
A cohort study comparing 4 mg and 10 mg daily doses of postoperative oestradiol therapy to prevent adhesion reformation after hysteroscopic adhesiolysis
Published in Human Fertility, 2019
Linlin Liu, Xiaowu Huang, Enlan Xia, Xiaoyu Zhang, Tin-Chiu Li, Yuhuan Liu
Asherman syndrome is characterized by the presence of intrauterine adhesions (IUAs) and/or fibrosis due to trauma to the basal layer of the endometrium. This may result in hypomenorrhoea, amenorrhoea, infertility or recurrent pregnancy loss. More than 90% of the cases are primarily caused by dilation and curettage (D&C) (Panayotidis, Weyers, Bosteels, & van Herendael, 2009; Yu, Wong, Cheong, Xia, & Li, 2008). Hysteroscopic adhesiolysis is a safe and effective means to divide adhesions and reconstruct a normal uterine cavity (Deans & Abbott, 2010; Magos, 2002). However, the most challenging problem in the management of moderate and severe IUA is the prevention of adhesion recurrence.