Understanding and treating intrauterine adhesions: Insights into molecular mechanisms and innovative therapies

Intrauterine adhesions (IUA) are a condition characterized by the formation of scar tissue within the uterine cavity, resulting from endometrial injury. They severely affect female fertility. Despite continuous optimization of diagnostic and therapeutic strategies, the recurrence rate remains high, indicating an incomplete understanding of the pathogenesis. This paper systematically reviews the cellular and molecular mechanisms involved in the formation of IUA as revealed by current research. It particularly emphasizes the critical roles of fibrosis-related signaling pathways, immune-inflammatory responses, angiogenesis, non-coding RNAs, epithelial-mesenchymal transition, genetic susceptibility, and mitochondrial function. Based on these molecular mechanisms, this article delves into groundbreaking approaches for both the prophylaxis and management of IUA. These strategies include modulating fibrosis signaling pathways, stem cell and exosome therapy, suppressing inflammatory responses, estrogen therapy, enhancing endometrial blood supply and angiogenesis, and platelet-rich plasma therapy. Additionally, this paper highlights the limitations of current research and discusses future research directions. It underscores the importance of integrating multi-omics research methods and developing precision medicine strategies. Thorough elucidation of the mechanism of IUA is crucial for its prevention and treatment and has important clinical significance.