Asherman’s Syndrome (Uterine Adhesions)

What is Asherman’s Syndrome?

Asherman’s syndrome, also known as uterine adhesions, is a rare, acquired medical condition of the uterus that is characterized by the formation of scar tissue or adhesions in the uterine cavity and changes in the menstruation cycle. The scar tissue or adhesions make the walls of the uterus fuse or stick together, reducing the size of the uterus leading to gynecologic abnormalities.

Causes

In most cases (about 90% of all cases), Asherman’s syndrome occurs in women who have had multiple dilation and curettage (D&C) procedures. Other potential causes of Asherman’s syndrome include:

Scar tissue formation as a result of Cesarean section
Intrauterine surgery to remove fibroids or polyps or to repair structural defects
Radiation treatment
Infections related to reproductive organs

Symptoms

Some of the common symptoms of Asherman’s syndrome include:

Hypomenorrhea (decreased menstrual flow)
Severe cramping and abdominal pain
Amenorrhea (absence of periods )
Infertility
Miscarriages

Diagnosis

Your doctor will review your medical history and perform a physical examination. As adhesions and other causes cannot be detected by physical examination alone, your doctor may order additional tests, such as:

Blood samples to rule out other disorders that could be causing your symptoms
Ultrasound of the uterus to examine the thickness of the uterine lining
Saline-Infused Sonohysterogram: a specialized ultrasound during which fluid is injected through the cervix into uterus in order to assess the uterine cavity and identify any scar tissue
Hysterosalpingogram (HSG): a combination of an x-ray and radioactive material is used to look for abnormalities in the uterine cavity and fallopian tubes
Hysteroscopy: the most effective way to diagnose Asherman’s syndrome – where your doctor inserts a hysteroscope with a camera into the uterus to look for scar tissue

Treatment

The main objective of the treatment is to make the uterus regain its normal shape and size by removing abnormal scar tissue or adhesions. This can be achieved by a surgical procedure called an operative hysteroscopy.

The procedure is conducted under local or intravenous (IV) anesthesia. A hysteroscope consisting of a camera and small instruments are placed into the uterus through the cervix. Your surgeon then removes the adhesions using the tiny instruments with the help of images displayed in the monitor from the hysteroscope.

Post-procedure, you may be prescribed antibiotics to prevent infection and/or estrogen to improve the quality of the uterine lining during the healing process.

Most women go home the same day of surgery, have swift recoveries, and require minimal pain medication post-surgery.