Effectiveness of a comprehensive treatment of intrauterine adhesions in reproductive age patients

• Mekan R. Orazov
• Lyudmila M. Mikhaleva
• Sevinc Ya. Ismayilzade

Abstract

Intrauterine adhesions associated with chronic endometritis represent a significant problem in reproductive medicine, substantially affecting women’s fertility. Existing approaches to preventing recurrence show insufficient effectiveness, necessitating the development of new therapeutic strategies targeting the main pathogenetic mechanisms of the disease. It appears relevant to study the effectiveness of a comprehensive approach that includes the use of an anti-adhesion barrier, cyclic hormone therapy, and physical factors.

The aim of the study was to evaluate the effectiveness of comprehensive treatment for intrauterine adhesions in patients of reproductive age.

Material and methods. The prospective randomized controlled study included 101 patients of reproductive age with verified diagnosis of intrauterine adhesions (N85.6) and chronic endometritis (N71.1) (mean age 34.98±3.71 years). Patients were randomized into two groups: the main group (n=50) received comprehensive treatment, including hysteroscopic adhesiolysis with anti-adhesion barrier, cyclic hormone therapy, and physiotherapy treatment (ultrasound therapy and dermatoparamic iodine electrophoresis); the comparison group (n=51) received standard treatment (hysteroscopic adhesiolysis). Effectiveness was evaluated after 3 months using control hysteroscopy.

Results. The recurrence rate was significantly (p<0.001) 3.5 times lower compared to standard hysteroscopic adhesiolysis (14.0% versus 49.0%). The risk of recurrence after comprehensive therapy was 0.286 (95% CI 0.147–0.556). A direct correlation was established between the severity of the adhesive process and recurrence rate (ρ=0.642, p<0.001). The proposed comprehensive therapy method demonstrated high effectiveness in surgical treatment outcomes for intrauterine adhesions in severe cases of adhesions, as well as a 2.5 times lower recurrence rate (33.3 vs 83.3%, p<0.001).

Conclusion. The use of comprehensive therapy allows not only to improve outcomes but also to significantly reduce the recurrence rate of intrauterine adhesions.

Keywords: intrauterine adhesions; chronic endometritis; anti-adhesion barrier; hormone therapy; physiotherapy; recurrence prevention; comprehensive treatment; hysteroscopy

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