Asherman's Syndrome

Asherman's Syndrome is an acquired uterine disease, characterized by the formation of adhesions (scar tissue) in the uterus. It is the presence of intrauterine adhesions that typically occur as a result of scar formation after uterine surgery, especially after a dilatation and curettage ( D&C ). The adhesions may cause amenorrhea and/or infertility.The extent of the adhesions defines whether the case is mild, moderate or severe. The adhesions can be thin or thick, can be spotty in location, or can be confluent. Scar tissue within the uterine cavity can interfere with conception, or can increase the risk of a miscarriage. Asherman's Syndromecan also occur after surgery inside the uterus, such as the removal of fibroid tumors or polyps. The adhesions form as raw or infected surfaces heal. The adhesions fill the uterus, sometimes blocking the cervical opening, menstrual flow can diminish or stop altogether.

Asherman's Syndrome is a gynecological disorder in which affected females experience a gradual decrease in menstrual flow, increased cramping and abdominal pain, eventual cessation of menstrual cycles (amenorrhea), and infertility. In rare cases, other infections or radium insertion into the uterus for the treatment of gynecologic cancers can lead to Asherman's Syndrome.

Synonyms of Asherman's Syndrome

• Intrauterine Synechiae
• Uterine Synechiae

Symptom of Asherman's syndrome

• No menstrual flow (amenorrhea) or decreased menstrual flow
• Infertility
• Recurrent miscarriages

These symptoms are more likely to indicate Asherman's syndrome if they occur suddenly after a D and C or other uterine surgery.

Causes of Asherman's syndrome

Asherman's syndrome can also occur after other types of uterine surgery. A severe pelvic infection unrelated to surgery may also lead to Asherman's syndrome. Asherman's is caused by an overly aggressive procedure called a D&C, which is performed following a miscarriage, birth or for evaluation of the uterus. 

Some causes of Asherman's Syndrome:

• Most commonly, intrauterine adhesions occur after a D&C (dilatation and curettage) that was performed because of a miscarriage or because of retained placenta with or without hemorrhage after a delivery.
• Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States, and uterine complications such as Asherman's syndrome related to these infections are even less common.
• Asherman's syndrome can also occur after other types of uterine surgery. It may be more likely to happen after a pregnancy-related D&C or if an infection is present in the uterus during the time of the procedure.
• There is a variant of Asherman's Syndrome that is more difficult to treat. This is a so-called "unstuck Asherman's" or endometrial sclerosis.

Treatment and Cure of Asherman's syndrome

Asherman's syndrome can be cured in most women with surgery, although sometimes more than one procedure will be necessary. Surgical treatment includes cutting and removing adhesions or scar tissue within the uterine cavity. After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent recurrence of the adhesions.

Asherman's syndrome should be treated if it is causing infertility or amenorrhea. Surgical treatment includes cutting and removing adhesions or scar tissue within the uterine cavity. Despite a possible prophylaxis (if a post-partum D & C is really necessary estrogen supplementation would help), keys to treatment include early recognition and treatment by a very experienced surgeon via hysteroscopy (sometimes assisted by Laparoscopy).

Those few surgeons experienced enough in treating severe Asherman's Syndrome recommend the avoidance of energy sources inside the uterus (this means removing scars with scissors rather than with energy-generating instruments such as resectoscopes or lasers, although not all surgeons agree with this).

After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent recurrence of the adhesions. Your health care provider may place a small balloon inside the uterus for several days, and he or she may prescribe estrogen replacement therapy while the uterine lining heals.

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