A rare condition known as Asherman syndrome affects the uterus when scar tissue forms inside it, reducing the space and affecting menstruation and fertility. An Asherman syndrome is usually caused by a procedure or surgery that damages the uterine lining, such as a dilation and curettage (D&C). It is diagnosed by ultrasound, hysteroscopy, or other imaging tests. The uterus is then reshaped and functioned normally after removing the scar tissue. It is important to avoid unnecessary D&C procedures and treat pelvic infections promptly. In this blog post, we will discuss the causes, symptoms, diagnosis, treatment, and prevention of Asherman syndrome in more detail.
The main cause of Asherman syndrome is damage to the endometrium, which is the inner lining of the uterus. This damage can result from:
Dilation and curettage (D&C) is a procedure that scrapes the inside of the uterus to remove tissue or stop bleeding. Asherman syndrome increases with the frequency and number of D&C procedures following a miscarriage, an abortion, or a retained placenta.
Other uterine surgeries, such as cesarean section, fibroid removal, or polyp removal.
Pelvic infections, such as tuberculosis, gonorrhea, or chlamydia, that spread to the uterus and cause inflammation and scarring.
Cancer treatments, such as radiation therapy or chemotherapy, that affect the uterus.
It is common for the body to form scar tissue when the endometrium becomes injured. This scar tissue, however, can be excessive and abnormal, leading to adhesions or bands of tissue that bind together the uterine walls. In addition to blocking the fallopian tubes, adhesions can also interfere with embryo implantation or endometrium shedding during menstruation.
The symptoms of Asherman syndrome vary depending on the severity and location of the adhesions. Some people may not have any symptoms at all, while others may experience:
Symptoms of Asherman syndrome include light or absent periods (hypomenorrhea or amenorrhea). The scar tissue may prevent blood from draining from the uterus, or reduce the amount of endometrium that can be shed.
A painful period, or dysmenorrhea. Some people feel cramps or pain in their lower abdomen or back during their period, but have no bleeding. This may indicate that blood is trapped inside their uterus due to adhesions.
Recurrent miscarriages or infertility. In addition to increasing the risk of complications during pregnancy, such as placenta previa, placenta accreta, or intrauterine growth restriction, scar tissue may prevent sperm from reaching the egg or the egg from implanting.
Pelvic pain or discomfort. The adhesions may cause inflammation, infection, or pressure in the uterus or the surrounding organs.
The following tests may be used to examine your uterus and look for adhesions if you have symptoms of Asherman syndrome, or have a history of uterine injury or infection:
In ultrasound imaging, sound waves create an image of your uterus and other pelvic organs. Ultrasound can show the thickness and shape of your endometrium, as well as detect any abnormalities or masses.
Hysterosalpingography (HSG) involves injecting a dye into your uterus and taking an X-ray, showing any blockages or irregularities caused by adhesions in the uterus.
During a hysteroscopy, a thin, flexible tube containing a camera and light is inserted into your uterus through your vagina and cervix. With hysteroscopy, your doctor can see the inside of your uterus and measure the adhesions. Hysteroscopy can also be used to treat Asherman syndrome by cutting or removing adhesions.
An MRI examines your uterus and other pelvic organs using a powerful magnetic field and radio waves to produce detailed images. An MRI can reveal the structure and function of the endometrium, and detect abnormalities and masses.
The main goal of treatment for Asherman syndrome is to remove the scar tissue and restore the normal shape and function of the uterus. Surgical procedures such as hysteroscopic adhesiolysis use hysteroscopy to cut or remove adhesions, which are most commonly used. The procedure usually takes one or more sessions depending on the severity of the condition and is usually performed under general or local anesthesia. In order to prevent adhesions from reforming, your doctor may also insert a device into your uterus after surgery, such as a balloon, coil, or intrauterine device (IUD). In order to stimulate endometrium growth and healing, you may also need to take hormones, such as estrogen or progesterone.
It is important to consider several factors when assessing the success rate of hysteroscopic adhesiolysis, including the location, size, and number of adhesions, the surgeon's skill and experience, and the quality of postoperative care. It is generally more successful to restore menstrual function than to restore fertility in mild to moderate cases of Asherman syndrome. About 70% to 80% of women who undergo hysteroscopic adhesiolysis resume normal periods, and 40% to 60% become pregnant.
The best way to prevent Asherman syndrome is to avoid or minimize the risk factors that can cause uterine injury or infection. Some of the prevention strategies include:
You should avoid unnecessary D&C procedures, especially after a miscarriage or abortion. If you have to have a D&C, ask your doctor to use gentle techniques and instruments, and monitor the procedure with ultrasound or hysteroscopy.
If you experience symptoms of a pelvic infection, such as fever, pain, discharge, or bleeding, see your doctor as soon as possible. You may need antibiotics or other medications to clear the infection.
It is important to protect yourself from sexually transmitted infections (STIs) that can affect the uterus, such as gonorrhea or chlamydia, by using condoms, limiting your sexual partners, and getting tested regularly.
After uterine surgery or cancer treatment that involves the uterus, you may need to take medications, use contraception, or avoid sexual activity for a certain period of time.
Despite being treatable, Asherman syndrome can also cause long-term complications, such as infertility, miscarriage, or pregnancy problems, especially in severe cases. If you experience symptoms of Asherman syndrome, or if you have a history of uterine injuries or infections, you should seek medical attention immediately. Early intervention and appropriate care can increase your chances of having a healthy uterus and a successful pregnancy.
