Asherman's syndrome
Key points
- 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).
- In most cases, it occurs after repetitive D&Cs are performed.
- 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.
- If your health care provider suspects Asherman's syndrome, he or she may recommend a transvaginal ultrasound examination or hysteroscopy (an outpatient surgical procedure).
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.
Written and revised by
Gerald Hurowitz, M.D.
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