Asherman syndrome is a rare gynecological condition that causes adhesions to form in the uterus. Your risk of developing this rare condition increases if you have had a D and C procedure.
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 be a sign that you’re menstruating, but the blood is unable to leave the uterus because scar tissue blocks the exit.
But if your periods are sparse, irregular, or absent, it may be due to another condition, such as:
- pregnancy
- stress
- sudden weight loss
- obesity
- overexercising
- taking a birth control pill
- menopause
- polycystic ovary syndrome
Contact your doctor or OB-GYN if your periods stop or become infrequent. They can use diagnostic tests to identify the cause and begin treatment if needed.
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.
If you have Asherman syndrome and become pregnant, your doctors can monitor you closely to minimize complications.
It’s also possible to treat Asherman syndrome with surgery. This surgery usually increases your chances of getting or staying pregnant.
Most cases of Asherman syndrome occur following a dilation and curettage (D and C) procedure.
Doctors generally perform a D and C for an incomplete miscarriage, a retained placenta after delivery, or an elective abortion.
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Sometimes adhesions can occur as the result of other pelvic surgeries, such as a cesarean section or the removal of fibroids or polyps.
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 your uterine lining and the follicles.
Hysteroscopy is possibly the best method to use when diagnosing 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 uterus 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 Asherman syndrome 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. You will be given a general anesthetic for the procedure.
After the procedure, your doctor will give you antibiotics to prevent infection and estrogen tablets to improve the quality of your uterine lining.
They will then perform a repeat hysteroscopy at a later date to check the operation’s effectiveness and that your uterus is free from adhesions.
There can be a risk of recurrence after surgery, so your healthcare provider may recommend waiting a certain amount of time before trying to conceive.
You may not need treatment if you do not plan to get pregnant 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 experience challenges 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.