Menstrual anomalies are often but not always correlated with severity: adhesions restricted to only the cervix or lower uterus may block menstruation. Pain during menstruation and ovulation is sometimes experienced and can be attributed to blockages. Note: not the same uterus as in ultrasound or hysteroscopic view; this uterus appears to be T-shaped. Hysteroscopic view.
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In many cases the front and back walls of the uterus stick to one another. In other cases, adhesions only occur in a small portion of the uterus. The extent of the adhesions defines whether the case is mild, moderate, or severe.
Some patients have no periods but feel pain at the time that their period would normally arrive each month. This pain may indicate that menstruation is occurring but the blood cannot exit the uterus because the cervix is blocked by adhesions. However, this is not often considered to be the case. The placenta may have attached very deeply in the endometrium or fibrotic activity of retained products of conception could have occurred, both of which make it difficult to remove retained tissue.
In this condition, which may coexist with the presence of adhesions, the uterine walls are not stuck together. Instead, the endometrium has been denuded. Although curettage can cause this condition, it is more likely after uterine surgery, such as myomectomy. In these cases the endometrium, or at least its basal layer, has been removed or destroyed. The condition is estimated to affect 1. Prevention Ideally, prevention is the best solution. So far, one study supports this proposal, showing that women who were treated for missed miscarriage with misoprostol did not develop IUA, while 7.
The advantage of misoprostol is that is can be used for evacuation not only following miscarriage, but also for retained placenta or hemorrhaging following birth. Therefore, immediate evacuation following fetal death may prevent IUA. Adhesions have a tendency to reform, especially in more severe cases. Many surgeons prescribe estrogen supplementation to stimulate uterine healing and place a splint or balloon to prevent apposition of the walls during the immediate post-operative healing phase.
Other surgeons recommend weekly in-office hysteroscopy after the main surgery to cut away any newly formed adhesions. However, for all women with intrauterine scarring and amenorrhea, including those who may have completed childbearing, there are other concerns.
Although the lack of menstrual periods could be secondary to hormonal abnormalities, it is more likely caused by either complete destruction of the uterine lining or by obstruction of the cervix or lower portion of the uterus; thus, menses are either retained in the uterus leading to pelvic pain and a condition called hematometra or flow into the abdominal cavity leading to endometriosis.
This risk is NOT increased and may be lower than in the general population. Therefore, pelvic ultrasound should be a routine part of their annual gynecologic visit.
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