Intrauterine synechiae occur in a variety of lengths and densities. Located between the walls of the uterus, they reduce its cavity, in severe cases completely obliterating the uterus (obliteration - overgrowth). In addition, synechiae can appear in the cervical canal, which leads to its fusion. In this case, the entrance to the uterine cavity is closed. There is another name for this disease - Asherman's syndrome. Among patients who suffer from infertility, intrauterine synechiae is diagnosed in almost every second one.

Causes of the disease

Currently, infectious, traumatic and neurovisceral causes of intrauterine synechiae are distinguished. One of the main factors is considered to be previous trauma to the basal layer of the endometrium. This occurs, as a rule, as a result of termination of pregnancy, after diagnostic curettage, operations in the uterine cavity (myomectomy, conization of the cervix). Trauma or inflammation leads to damage to the endometrium, which causes the release of fibrin. As a result, the walls of the uterus “stick together” and adhesions form.

Also, the disease often develops against the background of a frozen pregnancy - the remains of the placenta cause the activity of fibroblasts and the appearance of collagen before the regeneration of the endometrium. In addition, the development of the disease is influenced by the use of an intrauterine contraceptive.

Adhesions also appear with genital tuberculosis, its presence is confirmed by bacteriological examination or endometrial biopsy. It should be taken into account that an unfavorable factor that increases the risk of developing the disease may be intrauterine instillations, radiotherapy for tumors of the uterus or ovaries.

Symptoms of the disease

There are different degrees of severity of the disease.

In mild cases, the disease may be asymptomatic. However, later, depending on the degree of spread, the symptoms of intrauterine synechiae become more varied. The patient experiences pain in the lower abdomen, the intensity of which intensifies during menstruation. At the same time, the duration of menstruation decreases, they become scanty, and in severe cases, amenorrhea develops (absence of menstruation in women of fertile age). Infection of the lower area in the uterus with a normally functioning endometrium in the upper part leads to a disruption of the outflow of blood, which can result in the development of a hematometra. In this case, the clinic resembles the picture of an acute abdomen; in this situation, the patient needs emergency surgical care.

With extensive lesions in the uterine cavity with an insufficiently functioning endometrium, difficulties arise in the implantation of the fertilized egg. By the way, one of the reasons for the ineffectiveness of IVF - in vitro fertilization - is even mildly expressed adhesions. It should be taken into account that intrauterine synechiae are often accompanied by endometriosis (adenomyosis), which negatively affects the prognosis of treatment.

Patients often experience symptoms of intoxication, manifested by weakness, muscle pain, rapid heartbeat, and emotional instability.

Classification

Today, there are various classifications of intrauterine synechiae that provide complete information about the disease: type of histological structure, area of ​​damage, etc. Since 1995, the classification proposed by the European Association of Gynecologists (ESH) has been used, which distinguishes five degrees based on hysterography and hysteroscopy data. This takes into account the length of synechiae, the degree of damage to the endometrium, and occlusion of the mouth of the fallopian tubes.

Complications

As a result of a lack of functioning endometrium, as well as the formation of adhesions, the fertilized egg cannot attach to the wall of the uterus. In addition, the fertilization process itself may be disrupted due to overgrowth of the fallopian tubes. In 30% of patients with diagnosed synechiae, spontaneous abortion occurs, in 30% of women premature birth occurs. Pathologies of the placenta often occur. Thus, complications of intrauterine synechiae are very numerous; pregnancy in such women is associated with great risk. But, in addition to miscarriage, there is a possibility of postpartum hemorrhage.

Diagnostics

Currently, there is no uniform examination algorithm. However, according to most doctors, the diagnosis of intrauterine synechiae should begin with hysteroscopy; in case of doubtful results, hystersalpingography is recommended.

• Hysteroscopy is an examination of the inner surface of the uterus using endoscopic equipment (hysteroscope). The technique allows not only a visual examination of the cavity and detection of pathological changes, but also, if necessary, a biopsy or surgical intervention. This minimally invasive procedure is virtually painless and low-traumatic; it can be done under either local anesthesia or general anesthesia. The likelihood of complications after hysteroscopy is minimal.
• Hysterosalpingography is in some cases more effective than hysteroscopy. With dense, multiple synechiae, dividing the uterine cavity into chambers of various sizes, and connected by ducts, this study is more informative. However, deformation of the uterine cavity, the presence of mucus and endometrial fragments, etc., in some cases can lead to a false positive result. Therefore, it is better to entrust the choice of a suitable research method to a specialist.
• Ultrasound can detect single adhesions if there is no obstruction in the lower part of the cavity.
• MRI with contrast is a fairly effective diagnostic method that allows you to visualize possible pathology.
• Negative hormonal tests - when progesterone and estrogens are prescribed, there is no menstrual-like bleeding.

Treatment of intrauterine synechiae

The goal of therapy is to eliminate adhesions in the uterus and restore menstrual and reproductive functions. It must be emphasized that it is possible to decide how to treat intrauterine synechiae only after a thorough examination. Today, the only treatment method is dissection of synechiae. The nature of the operation depends on the type of adhesions, as well as the degree of damage. Weak synechiae are dissected with endoscopic forceps, scissors or the body of a hysteroscope; an electric knife or laser is used to remove denser strands. This intervention is a complex procedure, therefore, to prevent perforation of the uterine wall, it is carried out under visual control.

After surgery, hormone therapy is indicated, the purpose of which is to restore the endometrium. In the case where intrauterine synechiae arose as a result of infection, then after a biopsy and bacteriological examination, antibacterial drugs are prescribed.

Mild and moderate degrees of the disease respond well to treatment. In situations where synechiae are located in a limited area, in vitro fertilization is effective.

Prevention

To reduce the risk of developing pathology, there are several simple rules:

• Using competent contraceptive methods to prevent abortions
• Intrauterine manipulations are best performed in clinics where there is modern equipment and qualified specialists
• Timely treatment of urinary tract infections

It should be taken into account that in some patients, after treatment, there is a risk of developing a relapse, especially with dense widespread adhesions, as well as with tuberculous lesions. Therefore, the prevention of intrauterine synechiae after surgery plays a huge role. For these purposes, special devices are placed in the uterine cavity: IUD (intrauterine contraception), Foley catheter. In addition, hormone therapy is performed to restore the endometrium.

You should also remember the existing risk in women with a complicated course of the postpartum period or after an abortion. If there is a suspicion of placental remnants, in case of menstrual irregularities, etc., hysteroscopy should be immediately performed, the purpose of which is to clarify the exact localization of the pathology focus and its removal without injuring the normal endometrium.

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Gynecology

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Various pathological processes in organs, even after they are completely cured, can leave some complications and consequences. It is these unpleasant complications of inflammatory (most often) processes that include synechiae, which can form in the uterine cavity. What they are and how they affect the quality of life and reproductive function is described in this material.

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Definition

What are synechiae in the uterine cavity? Synechia is the medical name for adhesions, which are neoplasms of inextensible connective tissue that are formed as a result of inflammatory processes and are capable of tightening organs, deforming them, blocking their lumen, etc.

You can often hear that a diagnosis such as Asherman Syndrome is mentioned in the context of this topic. What is it? This is a disease that occurs only in women and is an adhesive process (the presence of synechiae in the uterus).

Structure

Reasons

Most often, this condition develops as complications after pathological and even therapeutic processes. Among them:

1. Inflammatory processes;
2. Infectious processes;
3. Processes with the formation of exudate;
4. Surgical interventions, cleansing, abortions (if we are talking about the uterus, etc.).

From a technical point of view, the process of formation of adhesions is associated with the fact that the tissue damaged during a pathological process or surgical intervention begins to be replaced by another. During such processes, fibrous connective tissue is always formed (it also forms, for example, scars and cicatrices), which does not perform any functions.

Classification

This pathological process can be classified in different ways. There are several types of classifications depending on the tissue composition of synechiae, their location, and the degree of development of the process. This classification system allows doctors to better navigate the process and is also important for determining the optimal treatment method.

According to histology

There are three types of synechiae based on tissue composition. They correspond to three stages of the syndrome.

1. The mild stage is characterized by the presence of adhesions of epithelial tissue. They are thin and easily cut;
2. The middle stage is characterized by the presence of denser, fibromuscular neoplasms, tightly germinated to the endometrium. They are more difficult to dissect and bleed when damaged;
3. The severe stage is distinguished when the synechiae are dense, consist of connective tissue and are difficult to dissect.

In principle, any stage can be cured surgically, but the scope and complexity of the intervention will vary.

By prevalence

In this case, we are talking about how much cavity volume is involved in the process.

• The first type is characterized by the involvement of up to 25% of the uterine cavity, the mouths of the tubes are not affected;
• The second type is distinguished when from 25 to 75% of the cavity is involved, the orifices are slightly affected, and there is no adhesion of the walls;
• The third type - more than 75% of the cavity is involved, the orifices are affected, there may be adhesion of the walls and deformation of the organ.

From the point of view of pregnancy, any type of pathology is undesirable, however, with the third type, conception is also very unlikely.

According to the degree of damage and closure of cavities and lumens

This is an international classification used by the Association of Gynecological Endoscopists. According to it, 6 stages of the syndrome are distinguished.

• I – thin films that are destroyed upon contact with the hysteroscope;
• II – denser films, often single;
• II-a – localization inside the uterine os, when the upper sections are not affected;
• III – dense multiple areas, estuaries are affected;
• IV – signs of the third stage are supplemented by partial occlusion of the cavity;
• V – signs of all other stages, as well as the presence of scars on the walls.

This classification is used only in the context of surgery.

Symptoms

Signs that synechiae have formed in the uterus can be different. But most often it is a persistent pain syndrome that occurs mainly during physical activity or placing the body in a certain position. In addition, this is possible with a full bladder and during menstruation. The pain can be sharp and sharp, of high intensity, or aching. Usually, they intensify with physical inactivity - in this case they can begin to appear even at rest.

Depending on the location of the formations, there may be problems with conception, including infertility and urination problems. Possible disruption of the outflow of menstrual blood. Disturbance of defecation, etc.

Diagnostics

Synechiae have a different density from other uterine tissues, which is why they are easily visualized during ultrasound. During an ultrasound, it is possible to determine both their actual location and the degree to which they cover the organ, how deformed it is, etc.

If it is necessary for diagnostic purposes to take synechiae tissue for histology, this is done during hysteroscopy. The same method can also be used to examine the uterine cavity for diagnostic purposes (if there are no obstacles to the penetration of equipment into its cavity).

Effect on pregnancy

Synechiae in the uterine cavity are a serious problem during pregnancy. This is due to the fact that these non-stretchable ties actually fix the organ in a static state. Thus, the walls of the uterus are at a fixed distance from each other. As the fetus grows, the organ enlarges and stretches; with adhesions, this leads to severe pain, hypertonicity of the organ, and as a result, miscarriage or abortion for medical reasons. If you neglect this recommendation, then theoretically even organ rupture could occur.

In addition, adhesions can be positioned in such a way that they deform the fetus, prevent it from growing, or put pressure on it. Resolution of pregnancy in this case will be the same as described above. Although most often, in the presence of adhesions, pregnancy is difficult. If they are present in the uterus, then the fetus is poorly attached, and if it is attached, then miscarriages occur in the early stages. But more often, problems exist even at the stage of conception - the cervical canal or fallopian tubes can be closed by adhesions.

However, after removal of synechiae, you can plan a pregnancy. Usually, depending on the individual characteristics of the body and the scope of the operation, the doctor recommends starting attempts to conceive within six months to a year after the removal.

Therapy

Treatment of this condition is carried out in several ways and, most often, in a complex manner, that is, several of them are used at once. All methods can be divided into two large groups - radical and conservative. Much in the choice of treatment depends on where the adhesions are located, how thick they are, and what histological composition they have.

Conservative

The following conservative methods of influence are most often used:

• Gynecological massage. The method is especially good for thin adhesions that have minimal elasticity and are small in size. During the massage, they are mechanically stretched, as a result of which the organ and/or its parts return to their normal physiological positions, and the lumens of the organs open. That is, in fact, the adhesion remains in place, but no longer causes discomfort. The method is not suitable for those who intend to give birth in the future, and is also ineffective when placing adhesions at the mouths of the fallopian tubes, cervical canal, etc.;
• Physiotherapy using microwave and/or UHF methods is indicated in the same cases as gynecological massage. Often these two methods are used together. Exposure to microwaves causes small adhesions to dissolve, while larger ones become more elastic and stretch more during the massage. The method is used as an additional method for both radical and conservative treatment;
• Therapeutic gymnastics is a special set of physical exercises, which is developed by a physical therapy doctor and is aimed at gradually stretching small adhesions so that they no longer cause discomfort. That is, this method is similar in principle to gynecological massage. In addition, it has the same indications, contraindications and scope of application. Most often, physiotherapy, gymnastics and massage are prescribed together when the degree of development of the pathology is insignificant.

All methods of conservative therapy are used in combination when the process is not severe. They are not suitable for those who are planning a pregnancy after removal of synechiae in the uterus, since they do not actually remove adhesions, but only make them such that, given the size of the organ, they do not cause discomfort. But as the uterus enlarges, they will make themselves felt again. An exception is physical therapy - in rare cases, this method promotes complete resorption of small adhesions, but often its effectiveness is not enough for a complete cure.

Radical

Radical treatment involves surgery. It involves inserting a scalpel into the uterus and directly cutting the adhesions. In some cases, their complete removal is necessary. Such an intervention can have different levels of severity depending on the method used, and the choice of method, in turn, depends on the structural features of the uterus, the location of adhesions in it, their size, etc.

Such an intervention is almost never performed lapartomically, since in most cases it is pointless, because as a result of such an operation new adhesions can form. Sometimes it is performed laparoscopically, when micro-instruments and a camera are inserted through punctures in the abdominal wall and the wall of the uterus with a diameter of 1.5 cm, and with the help of them the operation is performed according to the image from the camera that appears on the screen.

The least traumatic and most desirable method is hysteroscopic dissection, which involves inserting a hysteroscope tube into the uterine cavity through the cervical canal. Instruments and a camera are inserted through the tube and the intervention is performed. Although this method is preferred, it cannot be used in all adhesions locations.

Such dissection of synechiae in the uterus is usually complemented by a course of physiotherapy. Therapeutic gymnastics and gynecological massage can also be used during the recovery period and after it. This is done in order to prevent the formation of new, postoperative adhesions, and to stimulate the resorption of those small ones that may have remained after the operation.

Consequences

What happens if treatment is not carried out? The following consequences are possible:

1. Persistent pain syndrome;
2. Disruption of the functioning of organs and systems located nearby;
3. Organ deformation;
4. His injuries and damage;
5. Synechia in the uterus during pregnancy leads to miscarriage or abortion for medical reasons;
6. Infertility.

Not all adhesions lead to such problems, however, if there are indications for removal, then they cannot be neglected even if the patient does not plan to have children.

Conclusion

Uterine synechiae is a fairly serious problem, and it is a condition that requires treatment. Therefore, it is advisable to promptly consult a doctor if you notice symptoms of its presence.

Intrauterine synechiae - adhesions in the uterine cavity.

The appearance of synechiae in the uterine cavity leads to atrophic changes in the endometrium, which entails disruption of menstrual function. In addition, intrauterine synechiae are a mechanical obstacle to the advancement of sperm, as a result of which the woman suffers from infertility. There are also poor conditions for implantation of the fertilized egg, which leads to spontaneous abortion.

The trigger for the formation of intrauterine synechiae is damage to the basal layer of the endometrium, which, in turn, can be caused by various factors. The most common factors include:

• surgical termination of pregnancy;
• previous frozen pregnancy, in which possible remnants of the placenta in the uterine cavity contribute to the formation of collagen fibers;
• presence of intrauterine contraceptives;
• diagnostic curettage of the uterine cavity, carried out for endometrial polyps, fibroids, uterine bleeding, and so on;
• endometritis is an inflammatory disease that affects the endometrium;
• genital tuberculosis;
• radiation therapy performed for malignant tumors of the uterus or ovaries.

With timely detection, the prognosis of the disease is favorable, in most cases it is possible to restore menstrual and reproductive function. An unfavorable outcome is observed with intrauterine synechiae of tuberculous etiology. In this case, it is extremely rare to restore the condition of the endometrium. In addition, after dissection and removal of synechiae of any origin, there is a risk of the formation of new ones. Since intrauterine synechiae are a mechanical obstacle to the advancement of sperm, women often suffer from infertility. In this regard, such patients are offered assisted reproductive technologies, including in vitro fertilization. However, unfortunately, in some cases, even with the help of assistive technologies, women are unable to bear a fetus. In this case, it is proposed to consider the option of carrying a fetus through surrogacy.

Symptoms

As a rule, the presence of intrauterine synechiae is manifested by the development of hypomenstrual syndrome. This syndrome is characterized by the following:

• rare and short menstruation;
• low blood loss during menstruation compared to the physiological norm.

In rare cases, women with intrauterine synechia experience secondary amenorrhea (a pathological condition characterized by prolonged absence of menstruation in women who previously menstruated). When the lower parts of the uterine cavity are obliterated during menstruation, a hematometra can form - an accumulation of blood in the uterine cavity, resulting from a violation of its outflow. This phenomenon is accompanied by the appearance of pain in the lower abdomen. In most cases, the pain is cramping in nature.

Since the presence of intrauterine synechiae prevents implantation of the fertilized egg, women often suffer from infertility or miscarriage. The formation of synechiae in the fallopian tubes makes the process of fertilization impossible, which also leads to infertility. In such cases, artificial insemination techniques can be used, however, unfortunately, the presence of even the most minimal synechiae in the uterine cavity disrupts the implantation process, which can cause the ineffectiveness of in vitro fertilization.

Diagnostics

Diagnosis begins with clarifying the patient’s complaints, in particular assessing menstrual and reproductive function. You should also find out whether the woman has a history of abortions, intrauterine manipulations, for example, endometrial curettage, or inflammatory diseases of the reproductive organs. This is important to know, since it is these factors that often become the cause of the development of intrauterine adhesions.

Unfortunately, ultrasound of the pelvic organs in this case is a low-informative study, since the presence of intrauterine synechiae can be indirectly judged only by the irregular contours of the endometrium. The presence of a hematometra, which is expressed as an anechoic formation in the uterine cavity, is clearly visualized on ultrasound. The most informative are the following studies:

• hysteroscopy is an endoscopic research method that allows you to examine the uterine cavity using a hysteroscope. In the future, if necessary, not only diagnostic procedures, but also therapeutic ones can be carried out. Intrauterine synechiae are visualized as avascular whitish cords. These cords have different densities and lengths and connect the walls of the uterus. Due to their presence, deformation or obliteration of the uterine cavity is noted;
• Hysterosalpinography is an x-ray examination method that allows you to assess the patency of the uterus and fallopian tubes. However, it is worth noting that in some cases this study gives a false positive result due to the presence of mucus, endometrial debris, and so on in the uterine cavity.

Hormonal tests may also be prescribed, which are assessed by the presence of menstrual-like bleeding in response to estrogen and progesterone. In this condition, the hormonal test will be negative. In addition, the level of sex hormones is assessed, which is within normal limits, which indicates the normogonadotropic nature of amenorrhea.

Treatment

The main goal of treatment is to eliminate existing intrauterine synechiae, thereby restoring menstrual and reproductive function.

Of course, the most effective method is to perform surgical hysteroscopy, during which adhesions are dissected under the control of an optical device. Hysteroresectoscopy allows you to eliminate the existing problem without resorting to more complex interventions. Since this manipulation is considered minimally invasive, as a rule, the development of any complications is extremely rare in the future.

After surgical manipulation, the woman is prescribed hormone therapy, the effect of which is aimed at stimulating the restoration of the endometrium, as well as its cyclic transformation. It is important to note that in no case should you use combined oral contraceptives, since these drugs act on the endometrium, causing atrophic changes in it.

Since the formation of synechiae in the uterine cavity is often associated with inflammatory diseases of the genital organs, it is important to use antibacterial agents, the action of which is aimed at destroying pathogenic microflora. To avoid the development of a chronic form of inflammatory disease, which is often the cause of the appearance of intrauterine synechiae, it is necessary to carefully follow all the doctor’s recommendations during treatment of the acute form of the disease. You should also be careful when taking antibiotics; in particular, you should never discontinue the drug yourself or adjust the dosage and frequency of administration. In addition, after stopping the acute inflammatory process, physiotherapeutic treatment is prescribed, which reduces the possibility of the formation of adhesions in the pelvis. The following types of physiotherapy are used:

• UHF is a physiotherapeutic treatment method based on the use of an ultra-high frequency electromagnetic field;
• Magnetic therapy is a physiotherapeutic procedure based on the effect of a magnetic field on the body;
• electrophoresis with magnesium, zinc or hyaluronidase - administration of a drug through the skin or mucous membranes using a direct electric current;
• Diadynamic therapy is a method of physiotherapeutic treatment based on the use of electrical currents of various frequencies and powers.

Medicines

As is known, the main method of treating intrauterine synechiae is their dissection and removal during hysteroresectoscopy. After this surgical procedure, the woman is prescribed hormone therapy, which helps restore the endometrium. The selection of hormonal drugs is carried out by a specialist strictly individually in each individual case. While taking hormonal drugs, you should carefully follow all the doctor’s recommendations, and also not self-medicate, in particular, do not adjust the dose of the drugs or stop taking them without the knowledge of your doctor. Under no circumstances should combined oral contraceptives be used, since these drugs, on the contrary, cause atrophic changes in the endometrium.

If the disease is infectious, antibacterial agents are prescribed, the action of which is aimed at destroying pathogenic microflora. The choice of a specific group of antibiotics is based on the results of a study of scrapings from the cervical canal and cervix. Based on this study, it is possible to identify pathogenic microorganisms that are the cause of the development of the inflammatory disease, as well as determine their sensitivity to the antibiotics used. As a rule, until the results of the study are obtained, preference is given to broad-spectrum antibacterial drugs that act on both gram-positive and gram-negative microflora.

Folk remedies

Folk remedies are not used in the treatment of intrauterine synechiae, but their use can be encountered in the treatment of inflammatory diseases of the reproductive system, since they are often the cause of adhesions. In this case, traditional medicine based on herbal components is used for preventive purposes. It is also worth noting that these drugs should be used exclusively as an addition to the main treatment prescribed by a qualified specialist. We bring to your attention the following recipes, before using which you should consult with your doctor:

• To prepare the infusion you will need: 1 tablespoon of chamomile, 2 tablespoons of marshmallow leaves and 1 tablespoon of sweet clover herb. Mix the listed components thoroughly and pour in 1 cup of boiling water, let it brew for 20 minutes, then strain through a strainer. It is recommended to take ¼ cup 2 times a day after meals;
• mix 6 tablespoons of oak bark and 4 tablespoons of linden flowers. From the resulting collection, to prepare the infusion, you will need 4 tablespoons of raw materials, which are poured with 1 liter of boiling water and infused for 5 minutes, after which the infusion is carefully filtered. It is recommended to use for douching 2 times a day;
• take 4 tablespoons of dried chamomile flowers, pour 1 glass of boiling water over them, let it brew for 10 - 20 minutes. The infusion becomes ready for use after careful straining. It is recommended to take ½ glass orally 2 times a day;
• Take 1 tablespoon of pre-prepared plantain leaves, pour two glasses of boiling water, let it brew for 15 - 20 minutes, then strain through a strainer. The resulting infusion is consumed 1 tablespoon 3 – 4 times a day.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Synechiae are tight connections between various organs and the appearance of connective tissue bridges between them. In gynecological practice, two types of synechiae are most often encountered: changes in the structure of the labia minora in girls and intrauterine synechiae in adults.

Synechia of the labia in young patients occurs due to a lack of the hormone estrogen at a young age, as well as due to non-compliance with personal hygiene rules: insufficient care of the intimate area or, on the contrary, too intensive washing using aggressive cleansers.

Adhesions of the intrauterine cavity in adult patients occur as a result of complications during childbirth, induced abortions, and various intrauterine interventions.

The main method of getting rid of unwanted connections is to cut them. Methods for dissecting synechiae in girls and defects inside the uterine cavity are fundamentally different. The need for this intervention is determined taking into account possible indications and contraindications.

Carrying out the procedure

Dissection of synechiae in girls is carried out by detaching tissue using a special tool in the form of a stick with a rounded top. Before performing this manipulation, a topical anesthetic is applied to the area that will be subjected to further mechanical pressure, after which the actual disconnection is carried out very quickly (within a few seconds). The wound is treated with an antiseptic, after which the mother can take her daughter home.

Removing unwanted tissue in the uterus is a more complex operation. The manipulation is performed using a special optical device - a hysteroscope, thanks to which the doctor is able not only to carry out disconnection and other necessary manipulations, but also to visually monitor each action.

Depending on the complexity of the upcoming operation, the type of anesthesia is selected - local anesthesia or intravenous anesthesia. During the work, the doctor can additionally use various devices, for example, a Foley catheter, endoscopic forceps or scissors, or an “electronic knife”, in order to create natural channels inside the cavity and eliminate adhesions.

The thinnest films are easily cut by the body of the hysteroscope; denser ones are removed gradually using sharper instruments. Finally, when bleeding vessels are identified in the uterus, they are coagulated to stop the release of blood.

Indications for use

Elimination of existing connections is carried out if the following indications are present:

• the presence of fusion of the labia minora in small patients, if symptoms such as the outpouring of a stream of urine to the upper side, difficulty urinating, and the appearance of vaginal discharge are observed;
• reproductive dysfunction caused by the above cause;
• scanty menstruation (or its complete absence), the cause of which is the presence of this pathology;
• pain in the affected area, intensifying immediately before menstruation.

Principles of treatment

The separation of synechiae is carried out only after preliminary instrumental diagnosis and relevant tests (ultrasound, blood test, etc.). The impact can be carried out either as a separate small operation or during simultaneous implementation of other surgical interventions (for example, removal of polyps).

Along with surgical treatment, maintaining normal hormone levels is of great importance in the postoperative period. For this purpose, it is advisable to determine the content of estrogen and other substances in the blood. If certain disorders are detected, hormonal medications may be prescribed for up to six months after surgery. If signs of inflammation are detected, antibacterial therapy is carried out.