Intrauterine adhesions: hysteroscopic lysis and adjunctive methods

A series of 17 patients with significant intrauterine synechiae is presented with a demonstration of various adjunctive therapeutic measures which may be helpful. The procedure is ideally performed under ultrasound control and this is essential if the adhesions are extensive. There may be a place for postoperative use of an intrauterine contraceptive device or of hormone therapy, but these modalities are not universally accepted. However, 11 of 13 patients regained normal menstruation and 8 of the 10 desiring pregnancy achieved livebirths with these methods. Four of the latter had had severe adhesions. One patient (Case 9) was not seen after the postoperative visit ('lost to series') and 1 (Case 7) later had a hysterectomy for pain but the operative specimen showed a normal uterine cavity.