Intrauterine Adhesions / Asherman Syndrome

What is Asherman’s Syndrome?

Asherman’s syndrome, also known as uterine adhesions, is a rare, acquired medical condition of the uterus that is characterised by the formation of scar tissue or adhesions in the uterine cavity and changes in the menstruation cycle. The scar tissue or adhesions make the walls of the uterus fuse or stick together, reducing the size of the uterus leading to gynecologic abnormalities.

Causes of Asherman’s Syndrome

In most cases (about 90% of all cases), Asherman’s syndrome occurs in women who have had multiple dilation and curettage (D&C) procedures. Other potential causes of Asherman’s syndrome include:

  • Scar tissue formation as a result of Cesarean section
  • Endometriosis (inflammation of the mucous membrane lining the uterus)
  • Intrauterine surgery to remove fibroids or polyps or to repair structural defects
  • Radiation treatment
  • Infections related to reproductive organs
  • Use of intrauterine birth control devices

Symptoms of Asherman’s Syndrome

Some of the common symptoms of Asherman’s syndrome include:

  • Hypomenorrhea (decreased menstrual flow)
  • Severe cramping and abdominal pain
  • Amenorrhea (absence of periods )
  • Infertility
  • Miscarriages

Diagnosis of Asherman’s Syndrome

Your doctor will review your medical history and perform a physical examination. As adhesions and other causes cannot be detected by physical examination alone, your doctor will order additional tests, such as:

  • Blood samples to rule out other disorders that could be causing your symptoms
  • Ultrasound of the uterus to examine the thickness of the uterine lining and follicles
  • Hysterosalpingogram (HSG) - a combination of an x-ray and radioactive material is used to look for abnormalities in the uterine cavity and fallopian tubes
  • Hysteroscopy - the most effective way to diagnose Asherman’s syndrome – where your doctor inserts a hysteroscope with a camera into the uterus to look for scar tissue
  • Endometrial biopsy - A small tissue sample is obtained from the lining of the uterus to look for abnormal tissue growth under the microscope

Treatment of Asherman’s Syndrome

The main objective of the treatment is to make the uterus regain its normal shape and size by removing abnormal scar tissue or adhesions. This can be achieved by a surgical procedure called an operative hysteroscopy.

The procedure is conducted under general anaesthesia. A hysteroscope consisting of a camera and small instruments are placed into the uterus through the cervix. Your surgeon then removes the adhesions using the tiny instruments with the help of images displayed on the monitor from the hysteroscope.

Post-procedure, you will be administered antibiotics to prevent infection and estrogen to improve the quality of the uterine lining.

Most women go home the same day of surgery, have swift recoveries, and require minimal pain medication post-surgery.

A repeat hysteroscopy may be performed at a later date to ascertain the success of the operation and ensure the uterus is free from adhesions.

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