Asherman’s Syndrome

What is Asherman’s Syndrome?

Asherman’s Syndrome, also known as intrauterine adhesions or synechiae, is a medical condition in which scar tissue forms inside the uterine cavity. This scar tissue can stick the walls of the uterus together or create bands of tissue that can interfere with normal uterine function. Asherman’s Syndrome can range from mild to severe, and its severity determines the extent of symptoms and impact on fertility.

Who can get Asherman’s Syndrome?

Asherman’s Syndrome can affect women of any age who have undergone procedures involving the uterus, such as:

1. Dilation and Curettage (D&C): Most commonly, Asherman’s Syndrome occurs as a result of D&C, a procedure often performed after a miscarriage, abortion, or to remove abnormal tissue from the uterus.

2. Caesarean Section: In some cases, Asherman’s Syndrome can develop following a C-section, especially if there are complications during the procedure.

3. Myomectomy: Surgery to remove uterine fibroids can also lead to the formation of scar tissue if not performed carefully.

4. Uterine Infections: Infections of the uterus, particularly after childbirth or miscarriage, can increase the risk of Asherman’s Syndrome.

5. Endometrial Tuberculosis: In regions where tuberculosis is prevalent, this bacterial infection can contribute to Asherman’s Syndrome.

What are the Types of Asherman’s Syndrome?

Asherman’s Syndrome can be categorized into two main types:

1. Mild Asherman’s Syndrome: In this form, there are only a few small adhesions present in the uterine cavity. Mild cases often have fewer symptoms and a better prognosis for fertility.

2. Severe Asherman’s Syndrome: Severe cases involve extensive adhesions and scarring, leading to significant symptoms and a higher likelihood of infertility.

What are the Causes of Asherman’s Syndrome?

The primary cause of Asherman’s Syndrome is trauma to the uterine lining. This trauma can result from surgical procedures, infections, or inflammation within the uterus. The exact cause may vary depending on the individual case, but some common contributing factors include:

1. Repeated D&C procedures

2. Infections, particularly endometritis

3. Uterine surgery, such as myomectomy

4. C-section complications

5. Use of intrauterine devices (IUDs)

What are the Symptoms of Asherman’s Syndrome?

The symptoms of Asherman’s Syndrome can range from mild to severe and may include:

1. Menstrual Changes: Light or absent periods, or irregular menstrual cycles.

2. Pelvic Pain: Pain or discomfort in the pelvic region, especially during menstruation.

3. Infertility: Difficulty in getting pregnant or recurrent miscarriages.

4. Recurrent Pregnancy Loss: Women with Asherman’s Syndrome are at a higher risk of miscarriage.

5. Hormonal Imbalances: Hormone-related issues like amenorrhea (absence of menstruation) or hypomenorrhea (very light periods).

How is Asherman’s Syndrome Diagnosed?

Diagnosing Asherman’s Syndrome typically involves a combination of medical history, clinical evaluation, and imaging studies. Common diagnostic methods include:

1. Hysteroscopy: This is considered the gold standard for diagnosing Asherman’s Syndrome. It involves inserting a thin, lighted tube with a camera (hysteroscope) through the cervix to examine the uterine cavity.

2. Ultrasound: Transvaginal ultrasound may help detect abnormalities within the uterus.

3.Hysterosalpingography (HSG): A specialized X-ray procedure where a contrast dye is injected into the uterus to visualize the uterine cavity.

4. Sonohysterography: An ultrasound-based test that uses saline solution to create a clearer image of the uterine cavity.

5. MRI: In some cases, an MRI may be ordered to provide a more detailed view of the uterus.

How is Asherman’s Syndrome Treated?

The treatment of Asherman’s Syndrome aims to remove or break down the scar tissue and restore normal uterine function. The approach taken depends on the severity of the adhesions:

1. Hysteroscopic Adhesiolysis: This is a minimally invasive procedure where a hysteroscope is used to remove adhesions and scar tissue. It is often performed in mild to moderate cases.

2. Adhesion Barrier Gel: After adhesiolysis, an adhesion barrier gel may be placed in the uterine cavity to prevent reformation of scar tissue.

3. Hormone Therapy: In some cases, hormone therapy may be prescribed to promote the regrowth of the uterine lining.

4. Repeat Procedures: In severe cases, multiple procedures may be necessary to fully treat the condition.

5. Surrogacy: In cases where fertility cannot be restored, surrogacy may be considered as an option for having a child.

Conclusion

Asherman’s Syndrome is a challenging condition that can have a significant impact on a woman's reproductive health. However, with timely diagnosis and appropriate treatment, many women can regain their fertility and menstrual regularity. If you suspect you may have Asherman’s Syndrome or are experiencing symptoms, it is crucial to seek medical evaluation and guidance. Advances in medical technology and expertise offer hope to those affected by this condition, providing opportunities to achieve their family-building goals.