The Sticky Situation Nobody Talks About: Scar Tissue After Fibroid Surgery

By The Biomedical Observer

Here's a fun dinner party conversation starter you probably won't use: "Did you know that removing uterine fibroids can sometimes cause your uterus to basically glue itself shut from the inside?"

Yeah, I didn't think that would make it to your repertoire. But this is exactly what researchers are investigating in the clinical trial NCT07280286, studying the incidence of intrauterine adhesions following myomectomies. And spoiler alert - it's more common than you'd think.

Fibroids: The Uninvited Houseguests

Let's start with the basics. Uterine fibroids are benign tumors that grow in or on the uterus. They're ridiculously common - somewhere between 20-80% of women will develop them by age 50, depending on which study you believe and how hard they're looking. Most fibroids just hang out, causing no trouble, like that cousin who crashes on your couch but at least stays quiet.

But some fibroids are the obnoxious variety. They cause heavy bleeding, pelvic pain, frequent urination (because they're literally pressing on your bladder), and fertility problems. When fibroids become genuinely problematic, one common treatment is myomectomy - surgical removal of the fibroid while preserving the uterus.

Sounds straightforward, right? Remove the problem, keep the organ, everybody goes home happy.

Except there's a catch.

When Healing Goes Too Far

Your body is remarkably good at healing wounds. Cut yourself, and specialized cells rush in to patch things up. This is generally a fantastic feature - until it happens in the wrong place.

During myomectomy, surgeons have to cut into the uterine wall to remove fibroids. This creates wounds that need to heal. And here's where things get interesting: when multiple wound surfaces inside the uterus heal simultaneously, they can sometimes heal together. The front wall sticks to the back wall. The sides adhere to each other. Before you know it, you've got intrauterine adhesions - bands of scar tissue connecting surfaces that really should be staying separated.

When this process becomes severe, it's called Asherman syndrome, named after the Israeli gynecologist who described it in 1948. And let me tell you, it's no joke. Symptoms can include:

• Reduced or absent menstrual periods (because the endometrium can't build up normally)
• Infertility (because embryos can't implant properly)
• Recurrent pregnancy loss (because adhesions interfere with pregnancy development)
• Chronic pelvic pain

The Numbers Game

So how often does this actually happen after fibroid surgery? This is precisely what researchers want to better understand.

Current literature suggests the overall incidence of intrauterine adhesions following abdominal myomectomy is around 12.9%. That's roughly 1 in 8 patients developing some degree of adhesion formation. In about a third of these cases, the adhesions are classified as severe.

But here's where it gets complicated: the risk varies dramatically depending on the type of surgery and the characteristics of the fibroids being removed.

Surgical approach matters:
- Minimally invasive surgery (laparoscopic or hysteroscopic): ~9.4% adhesion rate
- Open abdominal surgery: ~23% adhesion rate

That's a more than two-fold difference, which probably explains the push toward minimally invasive techniques.

Fibroid location matters:
One study found that 87.5% of patients who developed adhesions had submucosal fibroids removed (those growing into the uterine cavity), compared to 58.6% of those without adhesions. When you're operating directly on the internal lining of the uterus, you're more likely to create surfaces that stick together.

Number of fibroids matters:
Patients who developed adhesions had a median of 22 fibroids removed, compared to 9.5 fibroids in those without adhesions. More cutting equals more healing surfaces equals more adhesion opportunities. It's simple math, just not the fun kind.

The Detective Work: Finding Adhesions

Here's a frustrating irony: adhesions often don't announce themselves. A patient might feel fine after surgery, have no obvious symptoms, and not discover she has adhesions until she tries to get pregnant and can't.

The gold standard for detection is hysteroscopy - threading a tiny camera into the uterus to look around directly. It's like a house inspection, but for your reproductive organs. Hysteroscopy allows doctors to see the exact location, extent, and severity of any adhesions.

More recently, 3D transvaginal ultrasound has emerged as a non-invasive screening option. Studies show it has about 98.8% sensitivity and 90.8% specificity for detecting adhesions. Not quite as definitive as looking directly, but much less invasive as a first-line test.

The challenge is that routine post-myomectomy screening isn't universally practiced. Many patients only get evaluated if they present with symptoms or fertility problems - by which point the adhesions may have become more established and difficult to treat.

Treatment: Unsticking the Stuck

If adhesions are found, operative hysteroscopy is the go-to treatment. A surgeon goes in with a camera and specialized instruments (typically tiny scissors or a laser) and carefully cuts through the scar tissue bands. It sounds straightforward, but it's actually quite delicate work - cut too aggressively and you can damage healthy endometrium, potentially making things worse.

Post-surgical management typically includes:
- Barrier devices: Placing a catheter or balloon in the uterus temporarily to physically keep walls separated while healing
- Estrogen therapy: Promoting healthy endometrial regrowth
- Anti-inflammatory medications: Reducing inflammation that can promote adhesion formation
- Follow-up hysteroscopy: Checking for adhesion recurrence and treating if needed

The good news is that for mild to moderate adhesions, treatment success rates are quite high - around 70-80% of patients can achieve successful pregnancies afterward. For severe adhesions or extensive endometrial damage, though, that number drops to 20-40%.

Why This Trial Matters

The clinical trial NCT07280286 is designed to better characterize the incidence of intrauterine adhesions following different types of myomectomy procedures. Understanding exactly how often this complication occurs - and what factors predict it - could help surgeons:

1. Better counsel patients: "Here's your actual risk of adhesion formation based on your specific situation"
2. Modify surgical technique: Perhaps certain approaches reduce adhesion risk
3. Implement prevention strategies: There's ongoing research into anti-adhesion barriers, specialized surgical techniques, and post-operative protocols that might reduce risk
4. Develop screening protocols: Should certain patients routinely undergo hysteroscopy 3-6 months post-surgery?

The Fertility Connection

For many women, the primary reason for choosing myomectomy over hysterectomy is to preserve fertility. The irony that the fertility-preserving surgery might itself cause fertility problems is... well, it's a lot.

This is why research like this trial matters. The medical community acknowledges that intrauterine adhesions after abdominal myomectomy could be "an important yet unrecognized factor in patients with fertility concerns after this surgery." Recognition is the first step toward prevention.

What Patients Can Do

If you're facing myomectomy and fertility is a concern, here are some questions to discuss with your surgeon:

• What type of surgical approach are you recommending, and why?
• What is my estimated risk of adhesion formation based on my fibroid characteristics?
• Do you use any anti-adhesion measures during surgery?
• Should I have a follow-up hysteroscopy to check for adhesions?
• If adhesions develop, what's the treatment plan?

These aren't accusatory questions - they're informed-patient questions. Good surgeons appreciate them.

The Bottom Line

Uterine fibroids are incredibly common, and myomectomy is often an excellent treatment option. But like any surgery, it comes with risks that deserve honest discussion. Intrauterine adhesions represent a real - if underappreciated - complication that can impact quality of life and fertility.

Research like NCT07280286 helps us understand these risks more precisely, which is the first step toward minimizing them. In medicine, you can't fix what you don't measure.

And hey, now you've got that dinner party conversation starter. Use it wisely.

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References:

• Incidence and risk factors of intrauterine adhesions after myomectomy. Fertil Steril. 2022;118(4):749-757.

• Intrauterine adhesions after abdominal myomectomy: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2025. doi:10.1016/j.ejogrb.2025.03.037

• Asherman's syndrome: current perspectives on diagnosis and management. Int J Womens Health. 2019;11:191-198. doi:10.2147/IJWH.S165474

• Intrauterine Adhesions and Asherman Syndrome: A Retrospective Dive into Predictive Risk Factors, Diagnosis, and Surgical Perspectives. Diagnostics. 2025;15(8):955.

• Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids. Obstet Gynecol Int. 2012;2012:853269. doi:10.1155/2012/853269

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Disclaimer: This blog post is for educational and entertainment purposes only. It is not intended as medical advice. Clinical trial information presented here is based on publicly available data and may not reflect the complete study findings. Always consult qualified healthcare professionals regarding medical conditions and treatments. Images and graphics are for illustrative purposes only and do not depict actual medical devices, procedures, mechanisms, or research findings from the referenced studies.