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What Is Asherman Syndrome?

Medically Reviewed by Melinda Ratini, DO, MS on May 28, 2021

Asherman syndrome is a condition that you can develop that affects women. It falls in the class of rare gynecological diseases, which affect the female reproductive system. The condition develops as scar tissue in either the uterus or cervix. The scar tissue causes the walls of the uterus to become thicker. They 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 getting 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 it 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.
  • Excessive bleeding. It can lead to pregnancy loss, infection, or could be a sign of an ectopic pregnancy. An ectopic pregnancy is a pregnancy that happens in your fallopian tube.

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 scraping or cleansing 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 leaves 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 endometrium 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:

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 wall 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. 

WebMD Medical Reference

Sources

SOURCES:

The American College of Obstetricians and Gynecologists: “Bleeding During Pregnancy,” “Dilation and Curettage.”

Anderson-Bagga, F.; Sze, A. StatPearls: “Placenta Previa.” StatPearls Publishing, 2020.

Current opinion in obstetrics & gynecology: “Intra-uterine adhesions and fertility outcome: how to optimize success?”

Ethiopian Journal of Health Science: “A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant management in Ethiopian Setup.”

Fertility Research and Practice: “Case report of pelvic tuberculosis resulting in Asherman’s syndrome and infertility.”

Geriatric Clinical Advisor: “Asherman’s Syndrome: Diagnosis.”

Indian Journal of Medical Research: "Female genital tuberculosis: Revisited."

International Asherman’s Association: “What is Asherman’s Syndrome?”

International Journal of Women’s Health: “Asherman’s syndrome: current perspectives on diagnosis and management.”

Journal of Reproduction & Infertility: “Reproductive Outcome of Patients with Asherman’s Syndrome: A SAIMS Experience.”

Mayo Clinic: "Ectopic Pregnancy," "How it works, what's normal."

National Organization for Rare Disorders: “Asherman’s Syndrome.”

Reproductive Facts: “Intrauterine Adhesions: What Are They?”

Reproductive Medicine Associates of New York: “Diagnosing and Treating Asherman’s Syndrome.”

The Royal Australian and New Zealand College of Obstetricians and Gynecologists: “Asherman Syndrome.”

Smikle, C., Yarrarapu, S., Khetarpal, S. StatPearls: Asherman Syndrome. StatPearls Publishing. 2021

Vital Record: “9 REASONS YOUR PERIOD IS LATE (IF YOU’RE NOT PREGNANT).”

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