Asherman's Syndrome

As women, our bodies go through a lot over a lifetime. In some women, pregnancy, surgery and other factors could lead to Asherman’s syndrome, a condition characterized by the development of scar tissue in the uterus. This scar tissue is also called adhesions.

Your symptoms may depend on the type of adhesions you have and how many you have in your uterus. In some cases they may be found together in one location, while in others they may be found throughout the uterus. Just as every woman is different, each woman’s experience with Asherman’s syndrome is unique.

What causes Asherman’s syndrome?

Most women develop Asherman’s syndrome after they have a surgery or procedure that involves the uterus.

Examples include:

• Post-delivery curettage (scraping of the lining of the uterus) to treat hemorrhaging or retained placenta
• Dilation and curettage (D&C) during abortion, for an incomplete miscarriage or to help reduce heavy bleeding

Sometimes, Asherman’s syndrome develops because of an infection of the uterus that occurs after delivering a baby, having a miscarriage or having an abortion.

Do I have Asherman’s syndrome?

It may be hard to know if you have symptoms of Asherman’s syndrome or if some other condition of the uterus is causing your problem. Mild adhesions from Asherman’s syndrome may not cause any symptoms, meaning you have normal periods and no pain.

However, having a lot of adhesions could possibly cause symptoms, such as infertility, miscarriage, cramping, pain and very light or completely absent periods. In the most severe cases, the scar tissue blocks the flow of menstrual blood, leading to complications.

Your doctor may order one or more tests to help diagnose Asherman’s syndrome, including:

• Endometrial biopsy — During this procedure, a sample of the lining of the uterus is taken and examined.
• Hysterosalpingogram (HSG) — During this test, a special dye is injected into your uterus, and then an X-ray is done to view the uterus.
• Hysteroscopy — During this procedure, a thin, lighted tube is inserted into the vagina in order to view the inside of the uterus.
• Sonohysterogram — During this test, fluid is injected into the uterus, and then an ultrasound is done to determine the thickness of the lining of the uterus.

Treatments

Your doctor will determine the stage of your condition — either Stage I (mild), Stage II (moderate) or Stage III (severe) — based on the amount and location of the adhesions found. The treatment needed will depend on the stage of your condition.

Sometimes, if there are no symptoms and no reason to be concerned about fertility, no treatment is needed.

When treatment is preferred, it is focused on breaking up the existing adhesions and preventing new ones from forming. Main Line Health offers minimally invasive procedures to treat Asherman’s syndrome, including ultrasound-guided removal of adhesions and placement an inflated balloon or an intrauterine device (IUD) to help prevent adhesions from regrowing after removal. Oral estrogen may also be prescribed to help prevent the regrowth of adhesions.

Although Asherman’s syndrome is a problem that never really goes away, your symptoms can be managed successfully. In most cases, treatment leads to more normal menstrual cycles and increased fertility.

To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (1.866.225.5654) or use our secure online appointment request form.