Understanding Asherman’s Syndrome: Causes, Symptoms, and Treatment

Intrauterine Adhesions

Intrauterine Adhesions (Asherman’s Syndrome) before adhesiolysis

Asherman’s Syndrome, also known as intrauterine adhesions or intrauterine synechiae, is a rare but significant gynaecological condition. This blog post aims to provide comprehensive information about Asherman’s Syndrome, including its causes, symptoms, and treatment options. By understanding this condition, we can raise awareness and help those affected seek appropriate medical care.

What is Asherman’s Syndrome?

Asherman’s Syndrome is characterised by the formation of scar tissue (adhesions) inside the uterus and/or the cervix. These adhesions can cause the walls of the uterus to stick together, leading to various reproductive issues. The condition varies in its severity from mild to severe, depending on the extent and location of the adhesions.

Causes of Asherman’s Syndrome

The primary cause of Asherman’s Syndrome is trauma to the endometrial lining of the uterus. This trauma often occurs after surgical procedures such as dilation and curettage (D&C), which is performed following a miscarriage, delivery, or elective abortion. Other potential causes include:

  • Pelvic surgery: Procedures like Caesarean sections, a retained placenta, fibroid removal, or polyp removal can lead to the development of adhesions.
  • Infections: Infections such as genital tuberculosis and schistosomiasis can also result in Asherman’s Syndrome.
  • Overly aggressive dilation and curettage: In some cases, an overly aggressive D&C (e.g. dilation of the neck of the womb to removed any retained products of conception) can cause significant damage to the endometrial lining, leading to adhesions.
Asherman's after Treatment

Healthy intrauterine cavity after treatment for Intrauterine Adhesions (Asherman’s Syndrome)

Symptoms of Asherman’s Syndrome

The symptoms of Asherman’s Syndrome can vary depending on the severity of the adhesions. Common symptoms include:

  • Scanty or absent periods (secondary amenorrhoea): Many patients experience a reduction in menstrual flow or complete absence of periods.
  • Pain during menstruation: Some patients may feel pain at the time their period would normally occur, indicating that menstruation is happening but the blood cannot exit the uterus due to blocked adhesions.
  • Infertility and recurrent miscarriage: Asherman’s Syndrome can lead to difficulties in conceiving and maintaining a pregnancy.

Diagnosis and Treatment

Diagnosing Asherman’s Syndrome typically involves imaging techniques such as hysteroscopy, which allows doctors to visualise the inside of the uterus and identify adhesions. Other tests include pelvic ultrasound, HyCoSy, MRI and saline infusion sonogram.

Treatment for Asherman’s Syndrome often involves surgical intervention to remove the adhesions and restore the normal uterine cavity. The most common surgical procedure is hysteroscopic adhesiolysis, where a hysteroscope is used to cut and remove the scar tissue. 

Post-surgical care may include using a device to prevent adhesions reforming, such as a coil or balloon catheter, and hormonal therapy to promote the healing of the endometrial lining and prevent the recurrence of adhesions. Other drugs such as vitamin E and Pentoxyphyline may be prescribed by your clinician to aid endometrial recovery. 

Success rates

Surgical treatment is generally very successful in restoring the natural menstrual cycle. Pregnancy rates after hysteroscopic adhesiolysis, by an experienced reproductive surgeon, ranges from 42-62%. Adhesions may reform in around a third of cases requiring further treatment, and repeat surgery may be necessary for very severe cases of Asherman’s. 

Conclusion

Asherman’s Syndrome is a condition that can significantly impact a woman’s reproductive health. By understanding its causes, symptoms, and treatment options, we can help those affected seek timely medical intervention and improve their quality of life. If you suspect you have Asherman’s Syndrome, it is essential to consult with a healthcare professional who specialises in reproductive surgery and fertility medicine, in order to obtain an accurate diagnosis and receive appropriate treatment.

If you would like more information or have any questions please ring or email Mandy Banbury, secretary to Mr Dobson.

Mandy Banbury:

Tel: 0115 966 2111 (Tues/ Wed/ Thurs)

Email: mandy.banbury@circlehealthgroup.co.uk