Synechiae are the fusion of the surfaces of the same organ or nearby surfaces of different organs.
Asherman's Syndrome (synechia in the uterine cavity) is a fusion of the walls of the uterus. The cause of the disease, as a rule, is mechanical intervention and a violation of the integrity of the basal layer of the endometrium, which usually occurs as a result of an abortion or after childbirth. Gynecologists claim that infection is a secondary factor that leads to the occurrence of synechia.
As a rule, synechia in adult women can occur most often when the fetus freezes. After cleansing the uterine cavity, in this case, the risk of developing synechia increases. This is due to the fact that the remains of the placenta activate fibroblasts and collagen formation before endometrial regeneration. If patients experience repeated miscarriages, synechia in the uterus develop in approximately 30% of them.
But there are other reasons as a result of which synechia develops in the uterine cavity. Often this happens:
- After myomectomy and metroplasty.
- As a result of diagnostic curettage of the uterine mucosa and conization of the cervix.
- Synechiae may result from the use of an intrauterine device.
As a rule, the symptomatology of the disease depends on the level of fusion of the uterine cavity. Also, if the lower part of the organ is overgrown, a hematometer may later form in the upper part. If the synechiae in the uterine cavity is characterized by a significant degree of overgrowth, this can lead to problems with bearing the fetus or the occurrence of infertility.
Women who begin to develop synechia in the uterine cavity may complain of pain in the lower abdomen, which is especially aggravated during menstruation. Moreover, the intensity of the pain depends on the location of the joints. If they are located at the bottom of the uterus or in the cervical canal, the pain is stronger, because in this case the synechia prevents the withdrawal of menstrual flow. If menstruation proceeds without irregularities, the pain is practically not noticeable.
As a rule, synechia in the uterus always causes an increase in pain during the onset of menstruation. The nature of menstruation also changes: the discharge becomes not so plentiful, and their duration is also reduced. If endometrial lesions are significant, then they become smearing, when the stage of the disease is very serious (in the case of complete overgrowth of the cervical canal or uterus), menstruation disappears completely.
To date, the only treatment used for this disease is surgery: dissection of synechia under the control of a hysteroscope. The operation is performed without causing injuries to the remaining endometrium. Features of the operation depend on the degree of complexity of the disease and on its type.
As experience shows, such treatment is highly effective. However, the larger the fusion, the lower the level of effectiveness. As a rule, the most difficult prognosis regarding the restoration of the menstrual cycle, reproductive function and relapse of the disease exists in the treatment of intrauterine synechia with tuberculous etiology.
Remember that the risk group is women with complications after childbirth (in the first months) and after abortion. If these patients experience complications in the form of malfunctions of the menstrual cycle, hysteroscopy should be performed to diagnose and destroy synechiae (if their formation has begun). If there is a suspicion of the presence of residues of the fetal egg, it is necessary to conduct not only curettage of the uterine mucosa, but also hysteroscopy (to clarify the focus of the pathology and its removal).