What is Asherman’s Syndrome ?
Asherman’s syndrome , also called uterine synechiae, presents a condition characterized by the presence of scars within the uterine cavity. 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 infertility.
In many cases the front and back walls of the uterus stick to one another. In other cases, adhesions only occur in a small portion of the uterus.
Asherman’s Syndrome Symptoms and Signs
Most patients with Asherman’s have scanty or absent periods but some have normal periods. Some patients have no periods but feel pain at the time each month that their period would normally arrive. Some common symptoms of Asherman’s Syndrome includes :-
- No menstrual flow (amenorrhea) or decreased menstrual flow.
- Recurrent miscarriage and infertility could also be considered as symptoms.
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.
Asherman’s Syndrome Causes
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.
Each case of Asherman’s Syndrome is different, and cause must be determined on a case-by-case basis. In some cases, Asherman’s may have been caused by an “overly-aggressive” D&C. Asherman’s syndrome can also occur after other types of uterine surgery. A severe pelvic infection unrelated to surgery may also lead to Asherman’s syndrome
Asherman’s Syndrome 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.
If tuberculosis or schistosomiasis infections are detected, antibiotic treatment will be necessary.
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.
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.