What is Asherman’s syndrome?
Asherman’s syndrome is an acquired condition (one you are not born with) that refers to having scar tissue in the uterus or in the cervix (the opening to the uterus). This scar tissue makes the walls of these organs stick together and reduces the size of the uterus. Asherman’s syndrome is also known as intrauterine synechiae or uterine synechiae. Synechiae means adhesions. Asherman’s syndrome is also called intrauterine adhesions (IUA).
How common is Asherman’s syndrome?
Asherman’s syndrome is considered a rare disease. It is hard to say how often it actually occurs because it is not always diagnosed. Some research estimates that IUA happen in nearly 20% of women who have had dilation and curettage (D&C) after pregnancy complications.
Symptoms and Causes
What are the symptoms of Asherman’s syndrome?
- Having very light periods (hypomenorrhea).
- Having no periods (amenorrhea).
- Having severe cramping or pain.
- Being unable to get or stay pregnant.
Some women have no symptoms, and some women have normal periods.
What causes Asherman’s syndrome?
- Scar tissue from uterine surgery like dilation and curettage (D&C). (This is the cause of more than 90% of IUA.)
- Scar tissue after a Cesarean section or from sutures used to stop hemorrhages.
- Infections of the reproductive organs.
- Radiation treatment.
Diagnosis and Tests
What tests are used to diagnose Asherman’s syndrome?
Your doctor will take a medical history and will do a physical examination. Adhesions will not be found by physical examination. A cervical blockage might be indicated if an instrument is not able to enter the cervix.
Your doctor might order hormone tests to rule out endocrine problems, or he or she might use hormones to try to induce bleeding.
Another option is saline infusion sonography (SIS), also called sonohysterosonography or ultrasound of the uterus. SIS uses saline solution that flows into the uterus to make imaging clearer.
Hysterosalpingography uses an X-ray to look inside your uterus. This procedure allows your healthcare provider the ability to see if there are any growths or blockages in your uterus or fallopian tubes.
The best way to diagnose Asherman’s syndrome is hysteroscopy. This procedure allows the doctor to put a telescope and camera into the uterus to see the whole uterine cavity.
Management and Treatment
How is Asherman’s syndrome treated?
The goal of treatment is to make the uterus regain its normal size and shape. In addition to diagnosis, hysteroscopy can also be used to treat IUA by cutting the adhesions with very small scissors, lasers, or other types of instruments that use hooks or electrodes. You might have to have more than one procedure. In addition, after the procedures, your doctor might prescribe hormones to let your uterine lining grow back correctly. This will allow you to have normal periods again.
Can Asherman’s syndrome be prevented?
Some researchers think that women who have any type of uterine surgery or injuries to the uterus should also have hormone therapy or mechanical separation of uterine walls after their procedures to prevent IUA. This means that a stent is left in the uterus for a period of time in order to stop IUA. Before trying to get pregnant, women who have had uterine surgeries may be advised to have imaging done to see if they have any type of adhesions.
In addition, research has shown that the timing of D&Cs can have some influence on adhesion formation. For instance, adhesions are more likely to happen if a postpartum D&C is done two to four weeks after delivery.
Outlook / Prognosis
What is the outlook for Asherman’s syndrome?
After treatment, when the uterus goes back to its correct shape and size, problems with menstruation should be resolved. This should help a woman to become pregnant if that is what she wants.