What Is Asherman's Syndrome?
Asherman's syndrome refers to when the uterine walls become inflamed and scarring results. This most often occurs following uterine surgery, recent pregnancy, or after a terminated pregnancy results in scarring. This scarring can be mild to severe, and in severe cases, cause the uterine walls to adhere together.
While there are many reasons that scarring may occur, the most common cause is a dilation and curettage procedure - This is a procedure to remove a placenta after birth, to abort a pregnancy, or to clear the uterus out after a miscarriage. Miscarriage and abortion are of a particularly higher risk of developing Asherman's syndrome, particularly if the termination or miscarriage was between 12 and 20 weeks of pregnancy.
What Are The Symptoms Of Asherman's Syndrome?
Asherman's syndrome symptoms include:
- Amenorrhea (No menstrual periods)
- Pain and cramping around the timing of menstruation
- Chronic miscarriages
- Invasive placenta
Diagnosis Of Asherman's Syndrome:
Diagnosis of Asherman's syndrome can be difficult and is often under-reported because it is not detectable through traditional examination and ultrasound. Instead, Asherman's syndrome is diagnosed using a diagnostic hysteroscopy. This essentially refers to a process by which the cervix is dilated and a small tube or catheter is placed inside the uterus. The tube contains a small scope camera that allows the doctor to see the inside of the uterus.
A hysterosalpingogram may also be used, by which a catheter is again inserted in to the dilated cervix, and a radioactive dye is injected in to the uterine cavity. This allows an x-ray to show the inside of the uterus.
Finally, diagnosis can also be made if the doctor is unable to insert the catheter because the uterus is blocked due to severe scarring. In this case, often a hysteroscopy is performed.
How Is Asherman's Syndrome Treated?
Once a positive diagnosis is made, seek a consultation with a surgeon specialized in this condition.
There are several methods of treating Asherman's Syndrome. They include:
- Removing the adhesions, or scar tissue. This is the most common treatment; however, it is important to work with a specialist because if the procedure is not performed correctly, the scarring may be exacerbated. This procedure requires that a scopic procedure be conducted with microscissors, allowing the surgeon to cut in to the endometrial lining and remove the scarring, without cutting through the endometrius. A balloon is then inserted and left in the uterus for seven to ten days to mitigate the uterine walls from re-adhering.
- Other surgical options include performing the hysteroscopies and removal of the scarring without the balloon. Often follow-up sessions are required to continue to mitigate the scarring.
- While a dilation and curettage procedure may be recommended by the surgeon, this is often a very dangerous procedure that may worsen or permanently damage the uterus. In addition, lasers and heat should not be used to treat the scarring, as it will cause new scarring.
It is important to get your adhesions removed regardless of any further pregnancy because having extensive scarring can increase the risk of developing endometriosis because the uterus or cervix is sealed shut.
Asherman's Syndrome And Pregnancy:
A major concern for women diagnosed with Asherman's syndrome is whether or not she will be able to carry a pregnancy to full term. The likelihood of a full-term pregnancy depends on a variety of factors. They include:
- How bad is the scarring
- The skill and expertise of the surgeon
- The amount of healthy endometrium left
If any of these factors are not correct, such as a thin or patchy endometrium, a pregnancy may not be possible. However, often this is the result of an aggressive or poorly conducted dilation and curettage procedure. As such, it is estimated that 70 to 80 percent of women diagnosed with Asherman's syndrome go on to have a full term pregnancy.
- Placenta previa
- Placenta increta
A diagnosis of Asherman's syndrome can be frightening and confusing. According to International Asherman's Association, here are some common questions related to Asherman's syndrome.
Can I have Asherman's syndrome if I've never had a dilation and curettage procedure? Yes, it is possible to have scarring, as there are other ways that trauma can occur. This includes cesarean sections, infection, or surgery.
I still menstruate every month. You can still have periods with Asherman's Syndrome, especially if you have a mild case. However it is not uncommon to have a shorter cycle or to notice other changes about your cycle. Keep in mind that if you are still menstruating, your cervix is still open and it is possible to get pregnant, which can be complicated if not totally at-risk.
Tell me about a hysterosu-pla-whatsit. A hysterosalpingogram (his-ter-oh-sal-ping-o-gram). Yeah, this procedure can be quite uncomfortable, the more so with more scarring. Cramping and discomfort are not uncommon up to hours after the procedure. Talk to your doctor if your pain or cramping extends beyond a few hours.
How is endometriosis related to Ashermans syndrome?If there is enough scar tissue present in the cervix that it becomes sealed closed, you become a higher risk for developing endometriosis. This is because the uterus is not able to shed the uterine lining, as would happen during menstruation. Instead, the tissue is reabsorbed or backflows into the abdomen. This can cause damage to the surrounding organs.
Read more about endometriosis.
Additional Resources On Asherman's Syndrome:
ParentingWeekly.com - This article is a description of Asherman's Syndrome, an overview of diagnosis and treatment options, and considerations regarding pregnancy.
International Adhesions Society - This is a website and group dedicated to adhesion resources and information. This site contains patient information, diagnosis, resources, and related information.
MedlinePlus - This website contains overview information related to Asherman's Syndrome.