Treatment of problems of the lining of the uterus
- Inflammation of the lining of the uterus (endometritis)
Usually endometritis is caused by some sort of infection. As a result treatment is generally antibiotics and anti-inflammatory drugs.
- Intrauterine Adhesions (Ashermans Syndrome)
The treatment of this condition involves removing the adhesions in an effort to re-establish the cavity of the uterus. While in many cases this can be achieved it is not universally possible. The dissection is usually performed under direct vision via hysteroscopy. It can also be achieved with X-Ray guidance with image intensification. Typically the walls of the uterus are then kept apart by the placement of an intrauterine device and hormone treatment with oestrogen followed by progestagen over the next month. Following treatment there remains an increased risk of miscarriage and other complications of pregnancy. Sometimes this procedure needs to be carried out more than once in order to completely remove all the adhesions.
- Endometrial polyps
These abnormal overgrowths of the lining of the uterus are usually simply treated by removal under hysteroscopic guidance or simple curettage.
Treatment of problems in the muscle of the uterus
- Fibroids (Leiomyomas)
Fibroids do not always require treatment. Indeed the majority of fibroids do not interfere with fertility. Fibroids which distorts the lining of the uterus (sub-endometrial or intracavitary fibroids) are of significance and should be treated. A surgical procedure is necessary to remove them - the operation is called myomectomy. This may be performed either via hysteroscopy or at open operation depending on the size and position of the fibroids. Open myomectomy is a major procedure which carries a risk of blood transfusion and even rarely hysterectomy. Hence it is only performed where absolutely necessary.
- Adenomyosis
Generally speaking adenomyosis rarely interferes with fertility. As the only curative treatment is hysterectomy, which is obviously inappropriate where fertility problems are present. IVF is the treatment of choice.