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Intrauterine adhesion (IUA) refers to the formation of fibrous tissue bands within the uterine cavity, often caused by intrauterine procedures. Mild cases present as thin fibrous bands, while severe cases can lead to complete occlusion of the uterine cavity. Clinical sequelae include infertility, recurrent pregnancy loss, menstrual abnormalities, and pelvic pain. The major clinical challenges lie in primary prevention of adhesions and prevention of postoperative recurrence. Intrauterine adhesion syndrome refers to fibrosis and scarring of the uterine cavity caused by prior intrauterine procedures such as abortion, curettage, or other surgeries, leading to reduced uterine volume and cavity deformation.
Western Countries
In Western countries, intrauterine adhesions are often associated with advanced maternal age and frequent intrauterine procedures. The prevalence of IUA is estimated at 1.5% [incidentally discovered during hysterosalpingogram (HSG)] to 21.5% (among women with a history of postpartum curettage). A meta-analysis of over 900 women evaluated by hysteroscopy within 12 months after spontaneous abortion (86% of whom had undergone curettage) found a prevalence of 19.1%. Even relatively minor procedures can cause IUA. Statistics show that intrauterine adhesion occurs in up to 20% of women after abortion, with a high recurrence rate, impacting reproductive quality.
Southeast Asian Countries
In Southeast Asia, due to less standardized medical procedures and lower health awareness among women in some regions, the incidence of intrauterine adhesions is relatively higher, especially after repeated curettage or infections, with reproductive-age women being particularly susceptible.
1. Infertility and Recurrent Miscarriage
Between 7% and 40% of women with IUA are infertile. Intrauterine adhesions can deform or obstruct the uterine cavity, preventing normal embryo implantation. This is a major cause of infertility and early miscarriage, and one of the most challenging problems in gynecology.
2. Abnormal Uterine Bleeding
Reports indicate that 70%–95% of women with IUA experience abnormal or altered menstrual bleeding patterns. Damage to the uterine structure often leads to hypomenorrhea, amenorrhea, or cycle irregularities, affecting endocrine balance and overall health.
3. Increased Pregnancy Risks
Even if conception occurs, IUA is associated with complications such as placenta accreta, placenta previa, and preterm delivery, posing risks to maternal and infant health. About 13% of patients experience recurrent pregnancy loss (≥3 miscarriages).
4. Cyclical Pelvic Pain or Dysmenorrhea
About 3.5% of IUA patients report cyclical pelvic pain, likely due to obstructed menstrual flow and/or hematometra. Such pain is often associated with amenorrhea or scanty menstruation.
5. Psychological and Emotional Problems
Chronic menstrual issues and infertility often lead to anxiety, self-doubt, and emotional distress, affecting marital relationships and overall quality of life.
Stem Cell Therapy
Stem cell therapy promotes regeneration and repair of the endometrium, addressing recurrent adhesions and endometrial dysfunction. It has rapidly developed in recent years, showing remarkable efficacy.
① Activates endometrial regeneration, restoring normal uterine morphology and function.
② Modulates the local immune environment, reducing inflammation and preventing recurrence.
③ Suitable for patients unresponsive to conventional therapies or those with multiple recurrences, improving pregnancy rates.
④ Shows enhanced efficacy when combined with hysteroscopic surgery.
1. Hysteroscopic Adhesiolysis
Hysteroscopic surgery is currently the standard treatment, allowing precise separation of adhesions. Postoperative drug therapy or physical methods are required to prevent recurrence.
2. Estrogen Support Therapy
Estrogen therapy, either postoperative or standalone, promotes endometrial proliferation, helps restore menstruation, and reduces adhesion formation. It is often used in combination with other methods.
3. Anti-Adhesion Materials
Postoperative placement of anti-adhesion balloons or stents in the uterine cavity prevents endometrial surfaces from fusing during healing, reducing recurrence risk. This is an important physical intervention.
4. Traditional Chinese Medicine (TCM) Adjunct Therapy
Herbal medicine aimed at promoting blood circulation, regulating menstruation, and relieving pain can improve endometrial perfusion. TCM plays a role in regulating constitution and supporting recovery, particularly in postoperative rehabilitation.
5. Antibiotic Prophylaxis
For patients with concomitant endometritis or postoperative infection risk, antibiotics help prevent infection and reduce adverse effects on endometrial recovery.
6. Physiotherapy and Rehabilitation
Infrared therapy, ultrasound, and other physiotherapy methods improve local uterine circulation, support repair, enhance treatment efficacy, and reduce the risk of postoperative recurrence.
7. Emotiona