Asherman syndrome is a rare condition that affects the uterus. In people with this condition, scar tissue or adhesions form in the uterus due to an injury.
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 people with Asherman syndrome have few or no periods. Some people have pain at the time their period should be due, but don’t have any bleeding.
This could indicate that you’re menstruating, but the blood is unable to leave the uterus because scar tissue blocks the exit.
If your periods are sparse, irregular, or absent, it may be due to another condition, such as:
- sudden weight loss
- taking the contraceptive pill
- polycystic ovary syndrome
Contact your doctor if your periods stop or become infrequent. They can use diagnostic tests to identify the cause and begin treatment.
Some people with Asherman syndrome have difficulties conceiving 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 may be higher than in people without this condition.
Asherman syndrome can also increase your risk during pregnancy of placenta previa, placenta increta, and excessive bleeding.
Your doctors can monitor your pregnancy closely if you have Asherman syndrome.
It’s possible to treat Asherman syndrome with surgery. This surgery can usually increase your chances of getting or staying pregnant. Doctors recommend waiting a full year after surgery before you begin trying to conceive.
Doctors generally perform a D and C for an incomplete miscarriage, a retained placenta after delivery, or an elective abortion.
If they perform a D and C between 2 to 4 weeks following delivery for a retained placenta, then there’s a 25% chance of developing Asherman syndrome. The risk of developing this condition increases the more D and C procedures a person 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 help your doctor see the condition of your uterus and fallopian tubes.
During this procedure, a doctor injects a special dye into the uterus to make it easier for them to identify problems with the uterine cavity, or growths or blockages to the fallopian tubes, on an X-ray.
Talk with your doctor about getting a test for this condition if you have:
- had uterine surgery and your periods have become irregular or stopped
- recurrent miscarriages
- difficulties conceiving
Doctors can treat Asherman syndrome using a surgical procedure called an operative hysteroscopy. A doctor attaches small surgical instruments to the end of the hysteroscope, which they then use to remove adhesions. A doctor will give you a general anesthetic for the procedure.
After the procedure, the doctor will give you antibiotics to prevent infection and estrogen tablets to improve the quality of the uterine lining.
The doctor will then perform a repeat hysteroscopy at a later date to check the operation’s effectiveness and that 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 does not occur.
You may not need treatment if you do not plan to conceive and the condition does not cause 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 you require a D and C, the surgeon can use an ultrasound to guide them and reduce the risk of damage to the uterus.
Asherman syndrome can make it difficult to conceive. It can also increase your risk of serious complications during pregnancy. But the condition is often preventable and treatable.
If you have Asherman syndrome and difficulty with fertility, consider reaching out to a support group. There are options for people who want children but experience difficulty getting or staying pregnant. These options include surrogacy and adoption.