What is Asherman syndrome?
Asherman syndrome is a rare, acquired condition of the uterus. In women with this condition, scar tissue or adhesions form in the uterus due to some form of trauma.
In severe cases, the entire front and back walls of the uterus can fuse together. In milder cases, the adhesions can appear in smaller areas of the uterus. The adhesions can be thick or thin, and may be sparsely located or merged together.
The majority of women who have Asherman syndrome have few or no periods. Some women have pain at the time that their period should be due, but don’t have any bleeding. This could indicate that you’re menstruating, but that the blood is unable to leave the uterus because the exit is blocked by scar tissue.
If your periods are sparse, irregular, or absent, it may be due to another condition, such as:
- sudden weight loss
- over exercising
- taking the contraceptive pill
- polycystic ovary syndrome (PCOS)
See your doctor if your periods stop or become very infrequent. They can use diagnostic tests to identify the cause and begin treatment.
Some women with Asherman syndrome are unable to conceive or have recurrent miscarriages. It is possible to become pregnant if you have Asherman syndrome, but the adhesions in the uterus can pose a risk to the developing fetus. Your chances of miscarriage and stillbirth will also be higher than in women without this condition.
Asherman syndrome also increases your risk during pregnancy of:
- placenta previa
- placenta increta
- excessive bleeding
Your doctors will want to monitor your pregnancy closely if you have Asherman syndrome.
It’s possible to treat Asherman syndrome with surgery. This surgery usually increases your chances of conceiving and having a successful pregnancy. Doctors recommend waiting a full year after surgery before you begin trying to conceive.
According to the International Asherman’s Association, about 90 percent of all cases of Asherman syndrome occur following a dilation and curettage (D and C) procedure. A D and C is generally performed following an incomplete miscarriage, retained placenta after delivery, or as an elective abortion.
If a D and C is performed between 2 to 4 weeks following delivery for a retained placenta, then there’s a 25 percent chance of developing Asherman syndrome. The risk of developing this condition increases the more D and C procedures a woman has.
If your doctor suspects Asherman syndrome, they’ll usually first take blood samples to rule out other conditions that could be causing your symptoms. They may also use an ultrasound to look at the thickness of the uterine lining and the follicles.
Hysteroscopy is possibly the best method to use in the diagnosis of Asherman syndrome. During this procedure, your doctor will dilate your cervix and then insert a hysteroscope. A hysteroscope is like a small telescope. Your doctor can use the hysteroscope to look inside your womb and see if any scarring is present.
Your doctor may also recommend a hysterosalpingogram (HSG). An HSG can be used to help your doctor see the condition of your uterus and fallopian tubes. During this procedure, a special dye is injected into the uterus to make it easier for a doctor to identify problems with the uterine cavity, or growths or blockages to the fallopian tubes, on an X-ray.
Talk to your doctor about being tested for this condition if:
- you’ve had previous uterine surgery and your periods have become irregular or stopped
- you’re experiencing recurrent miscarriages
- you’re having difficulties conceiving
Asherman syndrome can be treated using a surgical procedure called an operative hysteroscopy. Small surgical instruments are attached to the end of the hysteroscope and used to remove adhesions. The procedure is always carried out under general anesthetic.
After the procedure, you’ll be given antibiotics to prevent infection and estrogen tablets to improve the quality of the uterine lining.
A repeat hysteroscopy will then be performed at a later date to check that the operation was successful and your uterus is free from adhesions.
It’s possible for adhesions to reoccur following treatment, so doctors recommend waiting a year before trying to conceive to ensure that this hasn’t occurred.
You may not need treatment if you aren’t planning on conceiving and the condition isn’t causing you pain.
The best way to prevent Asherman syndrome is to avoid the D and C procedure. In most cases, it should be possible to choose medical evacuation following a missed or incomplete miscarriage, retained placenta, or post birth hemorrhage.
If a D and C is required, the surgeon can use an ultrasound to guide them and reduce the risk for damage to the uterus.
Asherman syndrome can make it difficult and sometimes impossible for you to conceive. It can also increase your risk for serious complications during pregnancy. The condition is often preventable and treatable.
If you have Asherman syndrome and your fertility cannot be restored, consider reaching out to a support group, like the National Fertility Support Center. There are options for women who want children but are unable to conceive. These options include surrogacy and adoption.