After abortion, there is often a combination of endometrial damage and infection at the same time, resulting in uterine adhesions, scar formation, low menstrual flow, and finally infertility. What are the causes of endometrial damage? Mechanical or infectious damage to the endometrium can lead to the development of uterine adhesions. The literature reports that the incidence of post-abortion uterine adhesions is about 19%, mostly associated with pregnancy-related curettage, commonly after abortion or spontaneous abortion clearance and postpartum bleeding clearance. Due to pregnancy, the uterus becomes very soft, and it is not easy to control the depth during scraping, or excessive scratching of the uterine cavity, excessive negative pressure during suction, too long, and repeated entry and exit of surgical instruments from the uterine orifice, which damages the endocervix or endometrium and causes postoperative endocervical adhesions or uterine cavity adhesions. Uterine fibroid excavation, endometrial tuberculosis infection, post-abortion endometritis, diagnostic curettage, or secondary infection after various uterine operations can also lead to the occurrence of cavity adhesions. What are the clinical changes of endometrial damage after curettage? If the menstrual flow becomes significantly less after abortion or curettage, or even if the menstrual flow does not occur, or if it is accompanied by periodic lower abdominal pain, it is important to be highly alert for the development of uterine adhesions. Some patients also need to be alert if they experience infertility or recurrent spontaneous miscarriage after the procedure despite no significant decrease in menstrual flow, and prompt medical consultation is recommended. How is endometrial injury diagnosed? Diagnosis of endometrial injury is found by medical history, physical examination, vaginal ultrasound, hysterosalpingography (HSG) and hysteroscopy. 1. Hormone test: In patients who do not have menstruation after curettage, if progesterone, estrogen + progesterone experiments are given and there is no withdrawal bleeding, postpartum uterine amenorrhea and uterine adhesions may be considered. If accompanied by periodic abdominal pain or ultrasound suggesting liquid dark area in the uterine cavity, consider the possibility of intrauterine fluid accumulation. 2.Ultrasound: Vaginal ultrasound indicates thin endometrium, interrupted endometrial line, and irregular liquid dark area in the uterine cavity, consider the possibility of uterine adhesions. Three-dimensional vaginal ultrasound is a rapidly developing ultrasound diagnostic technique in recent years, which can show the three-dimensional shape of the uterine cavity and is therefore more sensitive than conventional two-dimensional vaginal ultrasound for mild uterine adhesions. 3D ultrasound imaging is more intuitive, visual and non-invasive, and has the tendency to become the first choice for the diagnosis of uterine adhesions. 3. Hysterosalpingography: HSG is a more common test to diagnose uterine adhesions. If the HSG film shows filling defects in the uterine cavity, it suggests the possibility of uterine adhesions. 4. Hysteroscopy: Hysteroscopy is still the gold standard for diagnosing endometrial damage. The scope and type of endometrial injury can be determined under direct hysteroscopy, facilitating surgery to give the appropriate treatment. What treatments are available for endometrial damage? For patients with severe hysteroscopic adhesions, the serious damage to the endometrium makes the endometrium scarred in these patients, which not only makes them prone to the risk of re-adhesion after hysteroscopy, but also makes it difficult for a fertilized egg to be laid in such an environment, easily causing risks such as infertility and miscarriage. 1. Hysteroscopic removal of adhesions: The aim of treatment is to restore the normal shape of the uterine cavity, prevent recurrence of adhesions, repair the damaged endometrium and restore normal reproductive function. Once hysteroscopic adhesions are diagnosed, in the case of ineffective attempts to conceive, hysteroscopic techniques can diagnose hysteroscopic adhesions under direct vision and determine the type and degree of adhesions. Hysteroscopic resection of adhesions is currently the standard method of surgical treatment of hysteroscopic adhesions, and the mechanical clipping method is used in our center to avoid as much as possible irreversible thermal damage to endometrial tissue and basement membrane by electrodesiccation. 2. Estrogen therapy: Estrogen therapy may theoretically promote endometrial repair, but the dose, duration, and effect are very limited. However, there is no strong evidence that oral estrogen alone can have a significant effect on endothelium and conception.