Intrauterine Adhesions Usually Occur from an Injury to the Uterine Cavity and can Cause Infertility
Intrauterine adhesions usually occur from an injury to the uterine cavity. The most common cause is a D&C performed for a miscarriage. Much less commonly, adhesions can result from a severe intrauterine infection. Intrauterine adhesions can be minor, or they can affect the entire uterine cavity, possibly even leading to complete cessation of menstrual flow. These severe adhesions are called Asherman’s syndrome.
In order to repair the uterus, a resection of the intrauterine adhesions is performed hysteroscopically, sometimes under laparoscopic guidance. In cases of severe adhesions, it is preferable to place an intrauterine balloon into the uterine cavity after the procedure in order to keep the uterine walls apart as they heal. We typically leave the balloon in place for two weeks, and place the woman on relatively high dose estrogen pills during that time to encourage the uterine lining (endometrium) to regenerate and cover over the raw surfaces where the scar tissue used to be.
We also ask our patients to take an antibiotic, commonly tetracycline or a Z Pack, for the two weeks that the balloon is in place in order to decrease the risk that any infection might result from the balloon remaining in the uterus.
After the balloon has been removed in the office, we will ask you to continue the estrogen for an additional 10-14 days, and we will also ask you to take a progesterone pill for the last 10 days of the estrogen. When you stop both of those pills, you will have a menstrual period that may be a little heavier than a normal period.
We will then typically ask you to have another HSG performed in order to confirm complete resection of the adhesions. Although most adhesions can be successfully removed at hysteroscopy, it may require more than one procedure to treat severe adhesions.