Asherman syndrome is a condition that affects women's reproductive system. The condition develops as scar tissue in either the uterus or cervix. The scar tissue causes fibrous bands between the wall of the uterus to become thicker. The bands take up more space than usual, making the size of the uterus smaller.
In extreme cases, the walls can fuse together. The syndrome is also sometimes referred to as intrauterine adhesions. It’s hard to say how often Asherman syndrome occurs as it’s not always diagnosed.
How Does Asherman Syndrome Affect Fertility?
If you have Asherman syndrome, it may be hard for you to conceive. If you do, the chances of having a miscarriage are high. Getting pregnant while you have the condition is possible, but the adhesions in the walls of the uterus don't give room for fetal development. This makes your chances of having a miscarriage or stillbirth higher than with women without the condition.
Asherman syndrome also comes with a high risk of certain conditions during pregnancy, which include:
- Placenta accreta. The placenta attaches itself too deeply into the uterine wall. This leads to a high-risk pregnancy. After birth, all or part of the placenta remains attached, and it causes too much bleeding.
- Placenta Previa. The placenta blocks the cervix's opening, which can cause severe bleeding during pregnancy and birth. It also increases the risk of premature delivery.
Asherman syndrome is not a life-threatening condition but might expose you to recurrent miscarriages. Make sure you have regular doctor visits to have them monitor your pregnancy if you have Asherman syndrome.
Causes of Asherman Syndrome
The most common cause for the condition is surgical removal of tissue during a dilation and curettage surgery (D&C). The procedure is usually performed after an elective abortion procedure, miscarriage, or during the removal of a retained placenta after delivery. The trauma that results in the uterine walls after the procedure may lead to a scar.
If the surgery happens between two and four weeks after you give birth to remove a retained placenta, you have a 25% chance of developing Asherman syndrome. A retained placenta is when the placenta does not leave your body within 30 minutes of giving birth. It can happen if it gets trapped behind the cervix or if it is stuck to the uterine wall. The more of these procedures you have, the higher the risk of developing the condition. Uterine adhesions can also be because of other pelvic surgeries like a cesarean section or the removal of fibroids.
Another cause is endometrial infections like genital tuberculosis. Genital tuberculosis is when tuberculosis bacteria enter your reproductive system.
The cases of Asherman syndrome vary from one person to the other, and finding out your cause should be on a case-based approach.
A variant of the syndrome exists in which the uterine walls don't stick together. Instead, the endometrium is exposed, either because the basal layer has been removed or destroyed. Radiation treatment could also cause Asherman syndrome.
Symptoms of Asherman Syndrome
The most common symptom of Asherman syndrome is few or no periods. You may also feel pain when your period should be due but won't have any bleeding. This could be a sign that you’re on your period but blood can't leave your uterus because of the blockage.
However, other factors can cause you to not have your period, including:
- Hormonal abnormalities
- Menopause
- Over-exercising
- Stress
- Sudden weight loss
- Being on the contraceptive pill, or birth control
- Polycystic ovary syndrome
- Pregnancy
If your period suddenly becomes irregular or infrequent, see your doctor. The reason could be something else that requires treatment.
In other cases, you may have regular periods, or they could become very irregular. Other symptoms of Asherman syndrome are difficulty conceiving or recurrent miscarriages.
Diagnosis of Asherman Syndrome
Your doctor will take your in-depth medical history and do a physical examination. Only in rare cases will they find adhesions through a physical exam. However, they might find cervical blockage if a medical instrument is inserted and not able to enter the cervix.
They will also do a blood test to rule out other underlying conditions that would have these same symptoms. An ultrasound will also help see how thick the uterine lining and the follicles are.
Another method is to dilate your cervix and insert a hysteroscope, which is like a small telescope. The doctor will look inside your uterus to check for any scarring. The procedure is called hysteroscopy.
They might use this together with a hysterosalpingogram (HSG), where a special dye is injected into the uterus. It helps highlight all the issues within the uterine cavity, including blockages and growths, on an X-ray.
Treatment
Asherman syndrome is usually treated with surgery. The surgeon will cut and get rid of the scar tissue or adhesions. The surgery is non-invasive and done using a hysteroscopy. You will need general anesthesia, and estrogen may be prescribed after surgery to boost the quality of the uterine lining. Give the scar time to heal (about 12 months) before trying to conceive.
