Réactions de l'endomètre aux agressions instrumentales

Curettage and endometrial ablation aggress the endometrium of menorragic women, thus decreasing the menstrual volume. Curettage only ablates the superficial layer of the endometrium and menorragia reappears in 50% of the cases at one year. Various techniques of endometrial ablation result in a destruction of the basal layer, avoiding theoretically the regeneration of the endometrial glands. However, only 15 to 50% of the treated women become amenorrheic despite extensive destruction of the mucosa. The satisfaction rate is 90% after one year of follow-up, decreasing to 70 to 80% after five years. Thus, the endometrium regenerates, stimulated by the usual endocrine ovarian dysfunction occurring in women after 40 years. It is believed that the endometrium differentiates from remnants of the mucosa in the superficial myometrium, from deep adenomyosis, or that the mucosa regenerates laterally from unaltered cornual and/or isthmic endometrium. Radiologic, pathological and biological investigations of the uterus after treatment showed that the endometrial regrowth was limited. Indeed, this "new" functional endometrium changed in quantity (intrauterine adherences, retraction of the uterine cavity, local hemodynamic changes) and in quality (inflammatory reaction, scarred fibrosis, alteration of endometrial angiogenesis, decrease in matrix metalloproteinase activities reducing menstrual tissue breakdown). © Editions ESKA, 2007.