Intrauterine adhesions: Current diagnostic and therapeutic trends

In the period January 1981-December 1984, 31 cases of intrauterine adhesions (8 severe, 10 moderate and 13 minimal) were diagnosed at the First Department of Obstetrics and Gynecology, University of Milan. This pathology had altered the menstrual function in 21 subjects and reproductive capacity in 27. Synecholysis was performed at hysteroscopy, followed by application of an IUD in 7 patients and sequential treatment with estrogens and progestins in 22. After treatment 67.7% of the women had normal menstruation, and 40.7% of those wanting a child achieved pregnancy with live birth. Repeat hysterography and hysteroscopy after several months showed complete normalization of the uterine cavity in 62.5% of the women, and persistence of minimal and moderate adhesions in 25% and 12.5%, respectively. Dissection with miniature scissors under visual monitoring, followed by application of an IUD and sequential administration of estrogens and progestins seems at present the most effective therapeutic regimen for intrauterine adhesions.