Asherman’s Syndrome: Symptoms, Causes, Treatment

What are the symptoms of Asherman’s syndrome?

Asherman’s syndrome, also known as intrauterine adhesions or uterine synechiae, is a condition characterized by the formation of scar tissue within the uterine cavity. Symptoms of Asherman’s syndrome can vary depending on the extent and location of the adhesions, but common symptoms include:

1. Menstrual abnormalities: These can range from reduced menstrual flow (hypomenorrhea) to complete absence of menstruation (amenorrhea).
2. Infertility: Difficulty conceiving or recurrent miscarriages can occur due to the scar tissue affecting the uterine lining.
3. Pelvic pain: Some women may experience chronic pelvic pain or discomfort.
4. Recurrent pregnancy loss: The scar tissue can interfere with embryo implantation and development, leading to recurrent miscarriages.
5. Menstrual cycle changes: Changes in the menstrual cycle, such as lighter or less frequent periods, can occur.
6. Complications during pregnancy: If pregnancy occurs, there may be an increased risk of complications such as preterm labor, abnormal placentation, or intrauterine growth restriction.

It’s important to note that some women with Asherman’s syndrome may be asymptomatic and only discover the condition during an evaluation for infertility or recurrent miscarriages. If you suspect you have Asherman’s syndrome or are experiencing any of these symptoms, it’s important to see a healthcare provider for proper diagnosis and treatment.

What are the causes of Asherman’s syndrome?

Asherman’s syndrome, or intrauterine adhesions, is typically caused by trauma to the uterine lining (endometrium), which leads to the formation of scar tissue. Common causes include:

1. Dilation and Curettage (D&C): This is the most common cause of Asherman’s syndrome. D&C is a procedure used to clear the uterine lining after a miscarriage, abortion, or to treat certain uterine conditions. If performed too aggressively or if infection occurs, it can lead to scarring.
2. Uterine surgery: Other types of uterine surgeries, such as myomectomy (removal of fibroids), cesarean section, or surgery to remove uterine polyps, can also result in scar tissue formation.
3. Infections: Severe pelvic infections, particularly after childbirth, miscarriage, or abortion, can damage the uterine lining and lead to adhesions.
4. Radiation therapy: Radiation treatment for cancers in the pelvic area can damage the endometrial tissue, leading to scar formation.
5. Endometrial ablation: A procedure to destroy the uterine lining as a treatment for heavy menstrual bleeding can cause scarring and lead to Asherman’s syndrome.
6. Tuberculosis or schistosomiasis: In rare cases, these infections can affect the uterus and cause scarring, particularly in regions where these diseases are more common.

Preventing Asherman’s syndrome involves careful surgical technique and minimizing trauma to the uterine lining. If you have concerns about procedures that might lead to Asherman’s syndrome, discussing them with your healthcare provider can help you understand the risks and precautions that can be taken.

What is the treatment for Asherman’s syndrome?

Treatment for Asherman’s syndrome aims to remove the scar tissue and restore the normal structure and function of the uterine cavity. Common treatment options include:

1. Hysteroscopic adhesiolysis: This is the primary treatment for Asherman’s syndrome. It involves using a hysteroscope (a thin, lighted tube with a camera) inserted through the cervix to visualize the uterine cavity. Special instruments are then used to carefully cut or remove the scar tissue.
2. Adjuvant therapies: After adhesiolysis, adjuvant therapies may be used to help prevent the reformation of scar tissue and promote healing. These may include the placement of a balloon catheter or intrauterine device (IUD) to keep the uterine walls separated during the healing process. Hormonal therapy, such as estrogen therapy, may also be prescribed to stimulate the regrowth of the endometrium.
3. Repeat procedures: In some cases, multiple hysteroscopic adhesiolysis procedures may be needed to fully remove the scar tissue and restore the uterine cavity.
4. Surrogacy or adoption: In cases where Asherman’s syndrome causes severe infertility or recurrent pregnancy loss and other treatments are unsuccessful, surrogacy or adoption may be considered as alternative options for family building.
5. Fertility treatments: After successful treatment of Asherman’s syndrome, fertility treatments such as in vitro fertilization (IVF) may be recommended for women who are still experiencing difficulty conceiving.

It’s important to note that the success of treatment for Asherman’s syndrome depends on the extent and severity of the adhesions, as well as the underlying cause. Close monitoring by a healthcare provider experienced in the management of Asherman’s syndrome is essential to ensure optimal outcomes.