Asherman’s syndrome is a relatively rare condition where scarring and adhesions occur inside the uterine cavity (womb) and cervix. Adhesions are bands of fibrous tissue that form in the cavity of the uterus. The condition is sometimes referred to as intrauterine synechiae
What are the possible causes of Asherman’s Syndrome?
The problem most often occurs after uterine surgery but can also occur after infections. The most common cause of Asherman’s is curettage of the pregnant uterus. Possible causes include:
- Curettage of the pregnant uterus (e.g. a suction curette for a missed miscarriage). Repeated procedures increase the risk further.
- Intrauterine procedures such as myomectomy (fibroid removal) and curettage of the non-pregnant uterus
- Inflammation or infection. This is a less common cause but infections in the uterus after birth or miscarriage (endometritis) are associated with Asherman’s syndrome.
Why does the scarring occur?
All of the possible causes are similar in that they can cause inflammation and damage to the endometrium. This means the endometrium and its blood supply do not heal completely which can result in an ongoing defect.
What are the signs and symptoms of Asherman’s Syndrome?
Patients with Asherman’s syndrome may have issues with:
- Lighter or no periods
- Recurrent miscarriages
- Infertility
- Pain
- Placental disorders in pregnancy
How is Asherman’s diagnosed?
The possibility Asherman’s is normally raised on review of your clinical history.
The next step is imaging the uterus with ultrasound. Sometimes a sonohysterogram is performed. This is where the sonographer inserts fluid into the uterine cavity via the vagina and cervix while performing an ultrasound. This allows for clearer identification of lesions and adhesions within the uterine cavity.
Formal diagnosis and confirmation of Asherman’s syndrome is by hysteroscopy. This is a procedure where a small, fine camera is inserted into the uterus via the vagina and cervix. This allows for complete assessment of the cervix and uterus. Treatment may be performed at the same time.
When and how is Asherman’s treated?
Treatment is indicated when it causes problematic symptoms such as pain or when it potential contributor to recurrent as miscarriages or infertility.
Treatment consists of surgical division of adhesions in the uterine cavity via hysteroscopy. This is usually followed by a period of hormonal supplementation to support the uterine lining. In some cases an intrauterine device or splint may also be used to discourage adhesions from re-forming.
