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Asherman’s syndrome is scar tissue in the uterus that affects menstrual cycles and fertility, caused by surgery or infection. Symptoms include cramping, missed periods, and infertility. Diagnosis is done through ultrasound and surgery is the main treatment, but repeat surgeries may be necessary. Fertility may be restored, but severe cases may prevent carrying a child to term.
Asherman’s syndrome, also known as AS, is a term that describes scar tissue in the uterus that affects a woman’s menstrual cycle and fertility. This rare condition is usually the result of surgery or infection and presents with a multitude of symptoms resulting from inflammation of the uterine lining. Asherman’s syndrome is treated with surgery; while mild cases are often easily treated, moderate to severe cases may require ongoing monitoring and treatment.
AS is most often caused by various dilation and curettage (D&C) procedures. Curette scraping of the uterus, if done repeatedly, can leave scar tissue and cause intrauterine adhesions. It is estimated that nearly 8% of women who have had more than one D&C will develop this health issue. Asherman’s syndrome can also be caused by pelvic infections, tuberculosis and schistosomiasis, a parasitic infection. These diseases can cause inflammation of the female reproductive organs, potentially resulting in the formation of scar tissue.
The most common symptoms of Asherman’s syndrome are repeated miscarriages, excessive uterine cramping, and missing periods. AS often leads to infertility. These symptoms are caused by the narrowed space in the uterus as it fills with scar tissue. This leaves little room for implanting an egg into the lining; both menstrual periods and pregnancy are the result of implantation of an egg.
Asherman’s syndrome is diagnosed with a vaginal ultrasound, the same type of ultrasound used in early pregnancy. For a closer look at the uterine lining, a hysterosonography, similar to a vaginal ultrasound, or a hysteroscopy may be done to determine the exact location and severity of intrauterine adhesions. In combination with these diagnostic tools, blood tests are often done to rule out other possible problems.
AS is treated with a surgical procedure to remove scar tissue from the uterus. Because of the delicacy of the surgery, most cases of Asherman’s syndrome are best treated by surgeons who specialize in the condition. After the surgery, a balloon is placed inside the uterus for up to two weeks. This helps prevent new scar tissue from forming after surgery. While surgery for Asherman’s syndrome is often successful, many women will need several procedures because intrauterine adhesions often grow back after surgery.
In some cases, treatment for Asherman’s syndrome can resolve a woman’s fertility issues, allowing her to carry a baby to term. In cases of moderate to severe AS and in cases where repeat surgeries are needed, carrying a child may not be an option. With each surgery, more of the lining of the uterus is removed, and there comes a point where the lining is too thin to support a growing fetus.
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