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這件傷害子宮內(nèi)膜的事，別再做了！

出處：@祝秀英 日期：2024-06-21 17:00:31 編輯：網(wǎng)絡(luò)收集

近期，“強(qiáng)制墮胎”是一個(gè)熱門詞，這對(duì)女性的身心有巨大傷害。

強(qiáng)制墮胎其實(shí)就是人工流產(chǎn)，包括藥物流產(chǎn)和手術(shù)流產(chǎn)。這邊需要強(qiáng)調(diào)一下的是，藥物流產(chǎn)有再次清宮的可能。臨床上，的確有的女性做過一次人流之后就再也沒能懷孕。

很多女性都知道，人流會(huì)讓子宮內(nèi)膜變薄，但對(duì)于子宮內(nèi)膜與孕育的關(guān)系卻不清楚。

為此，我們請(qǐng)了在不孕不育臨床一線近40年的祝秀英主任來給大家說一說子宮內(nèi)膜與孕育的那些事。

子宮內(nèi)膜是孕育生命的土壤

子宮內(nèi)膜是構(gòu)成子宮體的最內(nèi)層的部分，其功能主要跟孕育新生命相關(guān)（子宮內(nèi)膜是孕育生命的土壤），附帶會(huì)產(chǎn)生周期性的月經(jīng)，經(jīng)期脫落排出。

子宮內(nèi)膜正常的厚度范圍是1——10mm,適宜懷孕的厚度是：8-12mm.

一個(gè)月經(jīng)周期里子宮內(nèi)膜厚度的變化：

增生早期：子宮內(nèi)膜相對(duì)比較薄，大概只有 4-6mm.

增生中期：子宮內(nèi)膜開始增長(zhǎng)，內(nèi)膜逐漸變厚，增長(zhǎng)到了 8-10mm.

增生晚期：子宮內(nèi)膜調(diào)整，內(nèi)膜厚度加寬，厚度有 9-10mm.

分泌早期：子宮內(nèi)膜由于受到孕激素的作用，子宮內(nèi)膜腺體變長(zhǎng)，子宮內(nèi)膜厚度受到刺激，出現(xiàn)糖原小泡。

分泌中期：子宮內(nèi)膜增長(zhǎng)，呈現(xiàn)鋸齒狀。厚度不變。

分泌晚期：子宮內(nèi)膜增厚，表現(xiàn)出現(xiàn)形狀是海綿狀。此時(shí)子宮內(nèi)膜的厚度約為 5-6mm.

月經(jīng)期：經(jīng)期女性的雌性激素，和孕激素都會(huì)下降，內(nèi)膜逐漸恢復(fù)平靜，開始增長(zhǎng)，調(diào)整，此時(shí)子宮內(nèi)膜的厚度可達(dá)到 8-10mm.

宮腔反復(fù)操作是內(nèi)膜過薄的主因

女性的子宮內(nèi)膜厚度低于7mm,就意味著子宮內(nèi)膜偏薄。

子宮內(nèi)膜偏薄除了跟基因、年齡、藥物相關(guān)以外，主要是跟反復(fù)宮腔操作史有關(guān)，大多數(shù)女性是頻繁做人工流產(chǎn)所致。

子宮內(nèi)膜過薄對(duì)生育的影響主要是降低女性生育概率、導(dǎo)致胎停育、自然流產(chǎn)和早產(chǎn)。

內(nèi)膜過厚也會(huì)影響生育

女性的子宮內(nèi)膜厚度高于10mm,就意味著子宮內(nèi)膜過厚。

子宮內(nèi)膜過厚，預(yù)示著可能存在卵巢功能紊亂、多囊卵巢綜合征、激素分泌異常等病變，這些疾病都會(huì)降低懷孕概率，甚至引發(fā)不孕。

祝秀英主任提醒：子宮內(nèi)膜偶爾變薄或增厚都不用擔(dān)心，如果與異常就交給醫(yī)生處理。

子宮內(nèi)膜異常的幾種情況

①子宮內(nèi)膜不均勻

  • 子宮內(nèi)膜不規(guī)則脫落

通常是內(nèi)膜在月經(jīng)來之前的正常狀態(tài)，月經(jīng)結(jié)束后恢復(fù)到正常狀態(tài)。

如果發(fā)現(xiàn)月經(jīng)后還是不均勻，考慮黃體萎縮不全（黃體本該在月經(jīng)結(jié)束后就消失的，卻仍然存在并釋放孕激素，導(dǎo)致部分內(nèi)膜尷尬的留在宮腔。）偶爾出現(xiàn)一次也不必處理，除非連續(xù)2次月經(jīng)周期后復(fù)查B超都是這個(gè)結(jié)果才考慮用藥治療。

  • 子宮內(nèi)膜增生

這是子宮內(nèi)膜長(zhǎng)期受到雌激素的持續(xù)刺激所致，主要表現(xiàn)為陰道不規(guī)則出血、月經(jīng)稀發(fā)、閉經(jīng)或閉經(jīng)后出血不止等。

由于子宮內(nèi)膜對(duì)雌激素反應(yīng)不同，所以出現(xiàn)子宮內(nèi)膜增生參差不齊，進(jìn)而有子宮內(nèi)膜不均勻的描述。這種情況需要依據(jù)實(shí)際情況選擇藥物、宮內(nèi)節(jié)育器、宮腔鏡手術(shù)或子宮內(nèi)膜去除手術(shù)等。

②子宮內(nèi)膜息肉

子宮內(nèi)膜息肉的形成可能與雌激素水平、慢性炎癥等因素相關(guān)。通常沒有任何癥狀，被發(fā)現(xiàn)也是因?yàn)橐鹆俗訉m異常出血或月經(jīng)量過多。

子宮內(nèi)膜息肉在B超下常會(huì)被描述為宮腔內(nèi)可見高回聲，但當(dāng)息肉較小且多發(fā)的時(shí)候，B超就可能會(huì)顯示子宮內(nèi)膜不均勻。

除此之外，還可能提示為子宮內(nèi)膜增厚、前后壁內(nèi)膜厚度不一致、蜂窩狀改變等。

確診有宮內(nèi)膜息肉，臨床上常用手術(shù)切除處理，通過宮腔鏡這種微創(chuàng)手術(shù)，直擊病灶，解決問題。

③內(nèi)膜狀態(tài)決定妊娠位置

常見妊娠位置有四種：宮外其他妊娠、輸卵管妊娠、宮角妊娠以及宮內(nèi)妊娠。這四種妊娠，除了宮內(nèi)妊娠，其他都需要及時(shí)終止妊娠，要不然會(huì)造成更大損傷。

這也就是說，子宮內(nèi)膜的狀態(tài)會(huì)決定妊娠的位置。

子宮內(nèi)膜覆蓋于子宮體腔面及宮體肌層，同時(shí)其腔內(nèi)內(nèi)膜受容性好，囊胚才越容易定位、粘附、侵入，胚胎著床成功幾率也就越高。

祝秀英主任提醒：

不論是自然受孕，還是試管嬰兒這種人工助孕，調(diào)整好子宮內(nèi)膜厚度都是至關(guān)重要的，因?yàn)閮?nèi)膜的狀態(tài)決定了能否受孕，以及受孕的位置和質(zhì)量，也就是說種地之前要先把土壤準(zhǔn)備好。

當(dāng)然，沒有生育計(jì)劃的女性平時(shí)應(yīng)做好避孕措施，如果意外懷孕，選擇人流手術(shù)一定要慎重，必要的情況下應(yīng)選擇正規(guī)醫(yī)院做人流手術(shù)。

此外，如果發(fā)現(xiàn)子宮內(nèi)膜薄、子宮內(nèi)膜不均勻、子宮內(nèi)膜增生等子宮內(nèi)膜異常的情況，及時(shí)就醫(yī)、配合治療，是可以讓子宮內(nèi)膜達(dá)標(biāo)，并盡快迎來好孕的

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