Do I Need Hysteroscopy Surgery for Uterine Adhesions?

Do I need to undergo a hysteroscopy?

In March 2014, I underwent surgery for uterine fibroids, which was performed via laparotomy.
My menstrual period ceased almost immediately after the second night post-surgery.
In March 2015, I had a hysterosalpingography, and the doctor reported no issues.
However, in June, I became pregnant, but unfortunately, I experienced a stillbirth in November.
After the induction of labor, I had significant bleeding a week later, and the placenta was retained in the vagina, requiring emergency medical intervention for removal.

A month later, my menstrual cycle did not stop for over two weeks.
The doctor recommended a dilation and curettage (D&C) procedure.
In March 2016, I underwent another hysterosalpingography, which revealed that the right fallopian tube was blocked, and there was adhesions in the right uterine horn.
The endometrial thickness during the ovulatory phase was only 0.56 cm.
The doctor suggested a hysteroscopic surgery to remove the adhesions, hoping to improve my menstrual cycle and endometrial thickness.

I am wondering if surgery is a viable method for improvement.
Would taking estrogen help with the adhesions and endometrial thickness, as I am concerned about damaging the endometrium?

Lin, 30~39 year old female. Ask Date: 2016/03/15

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if there are no abnormalities in the left fallopian tube, you can temporarily take estrogen to improve adhesions and endometrial thickness.
If this is ineffective, then consider hysteroscopic surgery.
Wishing you good health.

Reply Date: 2016/03/15

More Info

Hysteroscopy is a minimally invasive surgical procedure that allows doctors to examine the inside of the uterus using a thin, lighted tube called a hysteroscope. It is often used to diagnose and treat various uterine conditions, including uterine adhesions, also known as Asherman's syndrome. Given your medical history, including previous surgeries and complications, it is understandable that you have concerns about undergoing another procedure.

Based on the information you provided, it seems that you have experienced significant reproductive health challenges, including uterine fibroids, a miscarriage, and complications related to retained placental tissue. These issues can lead to scarring or adhesions within the uterine cavity, which can affect menstrual cycles and fertility. Hysteroscopy can be an effective way to identify and treat these adhesions, potentially improving your menstrual cycle and overall reproductive health.

While it is true that hormonal treatments, such as estrogen, can help stimulate the growth of the endometrial lining, they may not effectively resolve existing adhesions. In fact, hormonal therapy alone may not be sufficient to address the structural issues caused by adhesions. Hysteroscopy allows for direct visualization and removal of the adhesions, which can lead to a more significant improvement in menstrual regularity and endometrial thickness.

It is important to consider the potential risks and benefits of hysteroscopy. While it is generally considered safe, there are risks associated with any surgical procedure, including infection, bleeding, and injury to surrounding organs. However, the benefits of addressing uterine adhesions through hysteroscopy often outweigh these risks, especially if you are experiencing symptoms that significantly impact your quality of life.

In your case, since your doctor has recommended hysteroscopy to remove the adhesions and improve your endometrial thickness, it may be a necessary step to enhance your chances of a successful pregnancy in the future. It is crucial to have an open discussion with your healthcare provider about your concerns, the potential outcomes of the procedure, and any alternative treatments that may be available.

If you are hesitant about undergoing surgery, seeking a second opinion from another gynecologist or reproductive specialist can provide additional insights and help you make an informed decision. They can evaluate your specific situation, review your medical history, and discuss the best course of action tailored to your needs.

In summary, while hormonal treatments may provide some benefits, they are unlikely to resolve the underlying issue of uterine adhesions. Hysteroscopy is a targeted approach that can directly address these adhesions, potentially leading to improved menstrual cycles and reproductive outcomes. It is essential to weigh the risks and benefits with your healthcare provider and consider all available options before making a decision.

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