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Intrauterine adhesion (IUA) refers to the formation of fibrous tissue bands within the uterine cavity, often caused by uterine procedures. Mild cases present as thin fibrous bands, while severe cases can cause complete cavity occlusion. Clinical sequelae include infertility, recurrent pregnancy loss, menstrual abnormalities, and pain. Clinical challenges lie in primary prevention of adhesions and preventing postoperative recurrence. Intrauterine adhesion syndrome occurs after a history of uterine procedures such as abortion, curettage, or other intrauterine surgeries, leading to fibrosis in the uterine cavity, reduced uterine volume, and uterine scarring.
Europe and America
In Western countries, intrauterine adhesions are often related to advanced maternal age and frequent uterine procedures. The estimated prevalence ranges from 1.5% [incidentally detected by hysterosalpingogram (HSG)] to 21.5% (in women with a history of postpartum curettage). A meta-analysis including over 900 women who underwent hysteroscopy within 12 months after spontaneous miscarriage (86% of whom had curettage) found an IUA prevalence of 19.1%. Even relatively minor procedures can cause IUA. Statistics show that the incidence of intrauterine adhesion after abortion can reach up to 20%, with a high recurrence rate that impacts fertility quality.
Southeast Asia
In Southeast Asia, due to unstandardized medical practices in some countries or weak awareness of women’s health, the incidence of intrauterine adhesions is slightly higher, especially after repeated curettage and infections, making women of childbearing age more vulnerable.
1. Infertility and Recurrent Miscarriage
Between 7%–40% of women with IUA experience infertility. Adhesions can deform or obstruct the uterine cavity, preventing proper embryo implantation, becoming a major cause of infertility and early miscarriage, and posing a difficult challenge in gynecological practice.
2. Abnormal Uterine Bleeding
Reports indicate that 70%–95% of women with IUA have abnormal or altered menstrual bleeding patterns. Due to structural damage of the uterine cavity, women often present with hypomenorrhea, amenorrhea, or irregular cycles, affecting endocrine balance and overall health.
3. Increased Pregnancy Risks
Even after successful conception, intrauterine adhesions may lead to placental adhesion, placenta previa, preterm birth, and other pregnancy complications, threatening maternal and infant health. About 13% of patients experience recurrent pregnancy loss (≥3 losses).
4. Cyclic Pelvic Pain or Dysmenorrhea
Reports show that 3.5% of women with IUA suffer from cyclic pelvic pain, likely caused by blocked menstrual flow and/or hematometra. Thus, pain is often associated with amenorrhea or scanty menstruation.
5. Psychological and Emotional Issues
Long-term menstrual problems and infertility often lead to emotional anxiety, self-denial, and other psychological distress, affecting family, marriage, and overall quality of life.
Stem Cell Therapy
Stem cell therapy promotes regeneration and repair of the endometrium, addressing recurrent adhesions and endometrial dysfunction. It has rapidly developed in recent years with remarkable results.
① Stem cells can activate endometrial regeneration, restoring normal uterine structure and function.
② They regulate the local immune environment, reduce inflammation, and prevent recurrence of adhesions.
③ Suitable for patients unresponsive to traditional therapies or with multiple recurrences, improving pregnancy rates.
④ Combined with hysteroscopic surgery, the effectiveness is enhanced.
1. Hysteroscopic Adhesiolysis
Hysteroscopic surgery is the current standard, allowing precise separation of adhesions. Postoperative drug or physical interventions are required to prevent recurrence.
2. Estrogen Therapy
Postoperative or standalone estrogen therapy promotes endometrial proliferation, helps restore menstruation, reduces adhesion formation, and is often combined with other methods.
3. Anti-adhesion Materials
Postoperatively, anti-adhesion balloons or stents may be placed in the uterine cavity to reduce endometrial contact during healing, preventing recurrence—an important physical intervention.
4. Traditional Chinese Medicine (TCM) as Adjunct Therapy
By promoting blood circulation, regulating menstruation, and alleviating pain, TCM can improve endometrial blood supply, support recovery, and play a role in rehabilitation after surgery.
5. Antibiotics to Prevent Infection
For patients with concurrent endometritis or at risk of postoperative infection, antibiotics help prevent infection and reduce inflammatory damage to endometrial recovery.
6. Physiotherapy and Rehabilitation
Infrared therapy, ultrasound physiotherapy, and similar methods improve local uterine circulation, support endometrial repair, and reduce the risk of postoperative recurrence.
7. Emotional Counseling and Psychological Support
Given the challenges of repeated treatments and infertility, emotional counseling, family support, and professional psychological interventions are vital to recovery and patient confidence.
8. Comprehensive and Individualized Strategies
Treatment plans tailored to adhesion severity, age, and fertility needs integrate multiple methods to optimize therapeutic outcomes.
If left untreated, intrauterine adhesion syndrome may affect menstruation, fertility, and even cause severe complications. Experts from United Life International Medical Center state that stem cell therapy provides a new solution for complex or recurrent cases and should be actively considered within a comprehensive evaluation.
