How to determine whether there are adhesions in the uterus?

Uterine adhesions can be diagnosed through gynecological examination, ultrasound, hysteroscopy and other methods. Uterine adhesions may be related to factors such as induced abortion, uterine cavity infection, endometrial damage, etc., and usually manifest as symptoms such as decreased menstrual flow, amenorrhea, and infertility. It is recommended to seek medical treatment promptly and complete relevant examinations under the guidance of a doctor.

1. Gynecological examination

The doctor checks the position, size and mobility of the uterus through bimanual or trimanual diagnosis, and initially determines whether there are adhesions. If uterine movement is limited or cervical motion pain is obvious, it may indicate pelvic adhesions. Gynecological examination can also reveal menstrual blood retention caused by cervical canal adhesions, which manifests as periodic lower abdominal pain but no menstrual cramps.

2. Ultrasound examination

Transvaginal ultrasound can clearly show the continuity of the endometrial line. If intrauterine adhesions are present, endometrial echo interruption, uterine effusion, or endometrial thinning can be seen. Three-dimensional ultrasound can evaluate the scope of adhesions three-dimensionally, and is more sensitive to mild membranous adhesions. Ultrasound is noninvasive and repeatable, making it the screening method of choice.

3. Hysteroscopy

Hysteroscopy can directly observe the uterine cavity shape and adhesion sites, clarify the degree of adhesion and classify it, and is the gold standard for diagnosis. Examination shows that the uterine cavity is partially or completely closed, and the endometrial fibrosis is pale. Hysteroscopy can also perform adhesion separation during the examination, which is suitable for patients with moderate to severe adhesions.

4. Hysterosalpingography

By injecting contrast agent into the uterine cavity and taking X-rays, signs of adhesions such as uterine cavity filling defects and irregular edges can be displayed. This examination can assess fallopian tube patency, but may miss mild adhesions and has been gradually replaced by contrast-enhanced ultrasound. It is contraindicated in patients with iodine allergy or acute inflammation.

5. Magnetic resonance examination

MRI can display the relationship between the myometrium and endometrium in multiple planes, and has a high value in identifying cervical adhesions and muscular adhesions. Low-intensity adhesion bands can be seen on T2-weighted images, but the examination is more expensive and is usually used as a supplementary method in difficult cases. Patients with metal IUDs need to take them out in advance.

After diagnosis of uterine adhesions, treatment options need to be selected according to the condition. Mild adhesions can be treated with hysteroscopic separation combined with estrogen and progesterone cycles, while severe adhesions may require multiple surgeries. After surgery, it is recommended to use a uterine cavity support balloon to prevent re-adhesion, and conduct regular ultrasound examinations to monitor the endometrium repair status. Patients preparing for pregnancy need to grasp the timing of conception under the guidance of a doctor and avoid repeated uterine cavity operations. Pay attention to perineal cleaning every day and avoid bathing and sexual intercourse until complete recovery.