What are the symptoms of uterine adhesions after painless abortion?

Uterine adhesions after painless abortion may cause symptoms such as decreased menstrual flow, amenorrhea, periodic abdominal pain, and infertility. Intrauterine adhesions are mainly caused by endometrial damage, which may affect reproductive function and need to be confirmed by ultrasound or hysteroscopy.

1. Reduced menstrual flow

Intrauterine adhesions may cause the endometrial area to shrink or endometrial function to be damaged, which may be manifested as a significant reduction in menstrual flow or even spotting bleeding. Some patients still have regular menstrual cycles, but their menstrual periods are shortened to 1-2 days. This situation needs to be combined with hysteroscopy to evaluate the degree of adhesion. Mild adhesion can be treated by hysteroscopic separation. Postoperative estrogen and progesterone sequential therapy is used to promote endometrial repair, such as estradiol valerate tablets combined with progesterone capsules.

2. Amenorrhea

Severe intrauterine adhesions can lead to complete closure of the uterine cavity and secondary amenorrhea. The patient may experience a bloating sensation in the lower abdomen, and ultrasound may show that the endometrial line is interrupted or disappears. In this case, hysteroscopic adhesion lysis is required, and an intrauterine device or balloon stent is placed after the operation to prevent re-adhesion. At the same time, ethinyl estradiol and cyproterone tablets are taken orally to regulate endocrine.

3. Periodic abdominal pain

When there is partial adhesion in the uterine cavity, obstruction of menstrual blood discharge may cause progressively aggravated periodic lower abdominal pain, which often begins 1-2 days before menstruation. Some patients have pelvic tenderness and need to be differentiated from endometriosis. Treatment needs to relieve mechanical obstruction, and ibuprofen sustained-release capsules can be used for short-term postoperative pain relief.

4. Infertility or miscarriage

Intrauterine adhesions can destroy the environment for embryo implantation, leading to infertility or repeated early miscarriage. Examination showed abnormal uterine cavity shape and thin endometrium. The pregnancy rate of patients with moderate to severe adhesions may be reduced after surgery. It is recommended to use aspirin enteric-coated tablets to improve intimal blood flow under the guidance of a doctor, and to cooperate with assisted reproductive technologies such as frozen embryo transfer.

5. Other symptoms

A small number of patients may experience non-specific symptoms such as lumbosacral pain, dyspareunia, etc. When intrauterine adhesions are combined with infection, there will be abnormal secretions, and metronidazole vaginal effervescent tablets need to be used to control inflammation. Three-dimensional ultrasound needs to be reviewed regularly after surgery, and strenuous exercise and bathing should be avoided.

Sexual life and heavy physical labor should be avoided within 3 months after surgery, and the perineum should be kept clean. Increase the intake of high-quality protein such as fish and soy products in the diet, and supplement vitamin E and folic acid. If fever, abnormal bleeding or persistent abdominal pain occurs, timely follow-up is required. It is recommended that those who are not pregnant 6 months after surgery undergo a fertility evaluation and be referred to a reproductive medicine center if necessary.