Toward next-generation therapies for intrauterine adhesions: a perspective on granular hydrogel systems

Intrauterine adhesions (IUAs), often resulting from endometrial trauma following intrauterine surgical procedures, remain a significant clinical challenge in women's reproductive health. Conventional treatment strategies have shown limited effectiveness, prompting a shift toward advanced biomaterials-based solutions. Among these, minimally invasive procedures (MIPs) employing smart, injectable hydrogels have gained attention due to their potential to improve therapeutic outcomes. Despite their promise, many traditional hydrogel systems are constrained by inadequate injectability, limited porosity, poor conformability, and lack of structural heterogeneity. Recent advancements have introduced granular hydrogels-formed by the jamming of hydrogel microparticles-as a promising alternative. These microporous hydrogels offer enhanced injectability, tunability, and the ability to better replicate native tissue environments. This mini-review provides an overview of the current progress in utilizing microporous granular hydrogels for endometrial repair, emphasizing their advantages over traditional bulk hydrogels. It also discusses the challenges that remain in translating these innovative materials from laboratory research to clinical practice, and outlines future directions for optimizing their design and application in regenerative gynecology.