If you’ve recently been diagnosed with Asherman syndrome, you may be feeling overwhelmed and unsure of what to do next. Getting a diagnosis can be challenging, as the symptoms can be vague and often mistaken for other reproductive issues.
This article overviews Asherman syndrome, explains how it’s diagnosed, and provides information on the available treatment options to help you restore your reproductive health.
What is Asherman’s syndrome?
Asherman syndrome (also known as Asherman’s syndrome) is a rare but serious condition where scar tissue or intrauterine adhesions (IUA) form inside the uterus as a result of surgery or as a complication following miscarriage or delivery. These scars can partially or even completely block the space within the womb, making it difficult or occasionally impossible to get pregnant or carry a baby to term. It can also lead to other complications, such as irregular periods or pain.
Symptoms of Asherman syndrome
Common symptoms of Asherman syndrome include:
- Menstrual problems such as a lighter menstrual flow, shorter (hypomenorrhea), or absent periods (secondary amenorrhea)
- Infertility or recurrent miscarriages
- Severe period pain (dysmenorrhea)
- Retrograde menstruation, where blood flows backward through the fallopian tubes and out of the body rather than exiting through the vagina, during menstruation
Note: These symptoms could also be signs of other medical issues, such as polycystic ovary syndrome (PCOS), endometriosis, or adenomyosis. It’s important to see a healthcare professional for proper diagnosis. However, if these symptoms appear shortly after a uterine surgery or a dilatation and curettage (D and C) procedure, Asherman syndrome could be the underlying cause.
Not everyone with Asherman syndrome will experience all of these symptoms, and some people (particularly those who aren’t actively trying to conceive) might not notice any symptoms at all.
Diagnosing Asherman syndrome
A history of menstrual changes, infertility, or recurrent pregnancy loss following a uterine surgery, complicated delivery, or miscarriage might clue your doctor in to suspect a diagnosis of Asherma Syndrome. A standard transvaginal ultrasound can sometimes show signs suggestive of Asherman’s Syndrome, but to truly diagnose the condition, special imaging such as a hysterosalpingogram (HSG) and hysterosonography (saline infusion sonography or SIS) may also be used.
A hysterosalpingography is an X-ray of the uterus and fallopian tubes, while a hysterosonography uses ultrasound to get a better view of the inside of the uterus. If Asherman’s Syndrome is suspected, your doctor may recommend a hysteroscopy.
Hysteroscopy (HSC) is not only the most reliable and accurate diagnostic method for Asherman syndrome but is often the most appropriate initial treatment method (See below). During a hysteroscopy, a thin, lighted telescope is inserted through the cervix and into the uterus. This allows the doctor to see the inside of the uterine cavity and check for signs of scar tissue, adhesions, or other abnormalities.
Other imaging tests, including MRI and transvaginal ultrasound, cannot detect Asherman syndrome. Though they may reveal other uterine issues, they’re not reliable for diagnosing intrauterine adhesions.
A thorough medical history, physical exam, and bloodwork are important parts of the diagnostic process to rule out other conditions.
Causes and Risk Factors
The most common cause of Asherman syndrome is uterine tissue damage from prior surgical procedures, such as:
- Curettage of the basal layer of the endometrium shortly after pregnancy, often following an incomplete miscarriage, induced abortion, or postpartum hemorrhage
- Dilation and curettage or D and C procedures
- Abdominal and hysteroscopic myomectomy (removal of uterine fibroids)
- Surgical treatment of Mullerian anomalies
- Endometrial ablation
Other risk factors for Asherman syndrome include:
- Pregnancy-related complications, including cesarean sections, miscarriage, retained placenta (when placental tissue remains in the uterus after delivery), and other complications, particularly when someone experiences post-partum or post-operative infection or excessive bleeding.
- Insertion of intrauterine devices (IUDs)
- Infections such as genital tuberculosis and schistosomiasis
- Having one or more inflammatory conditions like endometriosis or pelvic inflammatory disease (PID)
Can Asherman syndrome be cured?
While there isn’t a cure for Asherman syndrome in the traditional sense, several effective treatment options can help manage the condition, restore the uterine lining (endometrium), and potentially improve fertility.
Hysteroscopic adhesiolysis (HA) is the gold standard for treating Asherman syndrome. It’s a minimally invasive procedure in which a doctor uses a hysteroscope (a thin, lighted instrument) to view the inside of the uterus and carefully remove scar tissue and adhesions from the uterine wall.
In addition to hysteroscopic adhesiolysis, a doctor may recommend:
- Estrogen therapy: After the adhesions are removed, estrogen therapy (often delivered through a small intrauterine catheter) can help stimulate the regeneration of a healthy uterine lining.
- Intrauterine balloon: After the adhesions are removed, the surgeon may insert a small balloon into the uterus to keep the layers of tissue separated while they heal and prevent adhesions from reforming. The balloon usually remains in for several days after the hysteroscopy and can be removed easily in the office. Antibiotics are often prescribed along with this treatment to prevent infection.
- Antibiotic and anti-inflammatory medication: These medications may be prescribed to prevent or treat infections and reduce inflammation after surgery, promoting healing and reducing the risk of new adhesions.
Not all women with Asherman syndrome require treatment. If a woman is asymptomatic and not trying to get pregnant, monitoring the condition may be the best approach. However, treatment is recommended for women experiencing symptoms or who are hoping to conceive.
Success Rates and Managing Treatment Outcomes
The success rates of treatment for Asherman syndrome vary depending on the severity of the scarring, the experience of the gynecologic surgeon, and the effectiveness of post-operative care. Frequently, multiple procedures may be required to completely restore the uterine cavity. When the treatment is successful, women with Asherman’s Syndrome may be able to conceive and carry a pregnancy, although the risk of recurrence can be as high as 33%. When the treatment is not successful, or patients are unable to conceive or carry a pregnancy despite treatment, some consider using a gestational carrier or surrogate to carry a future pregnancy.
Pregnancy and Asherman syndrome
In severe cases, Asherman syndrome can make it very difficult or impossible for a woman to get pregnant or carry a pregnancy to term. The scarring can distort and block the uterine cavity, preventing embryo implantation.
For women who can conceive, there’s a higher risk of pregnancy complications, including:
- Placental abnormalities like placenta previa (the placenta covers the cervix) or placenta accreta (the placenta attaches too deeply into the walls of the uterus)
- Recurrent pregnancy loss
- Preterm birth and low birth weight
Studies show that while treatment for intrauterine adhesions (IUAs) in women with infertility can lead to pregnancy rates of 40% to 80% and live birth rates of 30% to 70%, outcomes vary based on disease severity. Recurrence rates are significant, reaching up to 66% in severe cases, and pregnancies following treatment are often considered high risk due to complications such as placenta accreta, intrauterine growth restriction, and preterm delivery.
Advanced Reproductive Techniques and Their Effectiveness
While natural conception is possible for some women with Asherman syndrome, others may need assisted reproductive technologies (ART) to become pregnant.
These include:
- In vitro fertilization (IVF): IVF is often recommended for women with Asherman syndrome who’ve undergone hysteroscopic adhesiolysis to remove scar tissue. During IVF, embryos (fertilized in a lab) are transferred directly into the uterus.
- Intrauterine insemination (IUI): Although IUI is less effective than IVF, it may be an option for some women with mild Asherman syndrome. During IUI, washed and concentrated sperm are placed directly into the uterus.
- Gestational surrogacy: In severe cases of Asherman syndrome (where pregnancy is not recommended for medical reasons), gestational surrogacy may be an option. This involves using the expectant mother’s eggs or donated eggs (fertilized with the partner’s or donor’s sperm) and transferring the embryo to a surrogate’s healthy uterus to carry the pregnancy.
Note: The success of these advanced fertility treatments varies based on the severity of the woman’s Asherman syndrome, her overall health, her partner’s fertility status, and the outcomes of prior treatment.
Women with Asherman syndrome should prioritize finding a healthcare team that offers comprehensive monitoring and support to improve their chances of achieving their reproductive goals, whether through natural conception or ART.
Prevention and Early Detection
There isn’t a definitive way to prevent Asherman syndrome because it’s usually caused by injuries sustained during prior medical procedures rather than an inherent condition.
When possible, try to avoid D and C procedures and instead choose alternative treatments like suction curettage or vacuum aspiration, as these may be less likely to cause uterine scarring and adhesions. If you can’t avoid the D and C, ask your surgeon to use an ultrasound guide and be gentle to minimize trauma to the uterine lining.
Medications may sometimes be an alternative to surgery for managing certain conditions, like heavy periods.
Takeaway
Asherman syndrome is rare in which scar tissue forms inside the uterus. These are called intrauterine adhesions or intrauterine synechiae, which can lead to infertility and other reproductive problems.
Symptoms can vary, with some women experiencing lighter or absent periods, recurrent miscarriages, or pelvic pain, while others may have no symptoms at all.
Hysteroscopy is the gold standard for diagnosis, while treatment typically involves surgical removal of the adhesions (hysteroscopic adhesiolysis) followed by hormonal therapy and careful post-operative care to promote healing and prevent recurrence.
With the correct diagnosis and treatment, many women with Asherman syndrome can experience improved reproductive outcomes and overall well-being.
A Word from RMA Network
As fertility specialists who’ve dedicated years to helping women achieve their dreams of starting a family, we know just how emotionally and physically demanding Asherman syndrome can be.
We believe in empowering our patients with knowledge and support, guiding them through every step of their journey toward reproductive wellness. From diagnosis to treatment and post-operative care, we’re committed to giving them the best chance of success.
If you’re experiencing symptoms of Asherman syndrome or have been diagnosed with this condition, we encourage you to reach out. Our team is here to answer your questions, address your concerns, and provide you with the expert care you deserve. Together, we can explore your options and develop a personalized plan to help you overcome this challenge.
