Asherman’s syndrome

Definition

Asherman’s syndrome 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 (lack of Menstrual Periods) and/or infertility.

Causes, incidence, and risk factors

Asherman’s syndrome is a rare condition. In most cases, it occurs after repetitive D&Cs are performed. A D&C may be performed following some miscarriages, in some elective surgical abortions, and to treat certain other problems related to the uterus such as heavy menstrual bleeding.

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. A severe pelvic infection unrelated to surgery may also lead to Asherman’s syndrome.

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.

Symptoms

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

These symptoms could be related to several conditions and are more likely to indicate Asherman’s syndrome if they occur suddenly after a D&C or other uterine surgery.

Signs and tests

A pelvic exam is usually normal. If your health care provider suspects Asherman’s syndrome, he or she may recommend a transvaginal ultrasound examination or hysteroscopy (an outpatient surgical procedure).

During hysteroscopy, a small camera is inserted through the cervix that allows your doctor to look at the inside of your uterus under magnification. These tests may reveal scar tissue partially or completely filling the uterine cavity.

If infertility is a problem, other tests or evaluations may be recommended.

Lab tests that detect Tuberculosis or schistosomiasis may be recommended if these infections are suspected.

Treatment

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. This can usually be performed by hysteroscopy, using small instruments and a camera placed into the uterus through the cervix.

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.

Antibiotic treatment may be necessary if infection is identified.

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See http://www.ashermans.org for information about an online Asherman’s syndrome support group.

Expectations (prognosis)

Asherman’s syndrome can be cured in most women with surgery, although sometimes more than one procedure will be necessary. Approximately 70-80% of women who are infertile because of Asherman’s syndrome will have a successful pregnancy after treatment.

Complications

Complications of hysteroscopic surgery are uncommon and include bleeding, perforation of the uterus, and pelvic infection.

In some cases, treatment of Asherman’s syndrome will not cure infertility.

Calling your health care provider

Call your health care provider if your Menstrual Periods do not resume after a gynecologic or obstetrical procedure. An evaluation for infertility is also warranted if you are unable to achieve a pregnancy after 6 to 12 months of trying.

Prevention

Most cases of Asherman’s syndrome cannot be predicted or prevented. However, cases that follow a D&C may be preventable if antibiotics are given prior to the procedure.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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