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What is Asherman syndrome? symptoms and causes

By Dr. Jesús Alberto Félix Atondo

Asherman’s syndrome is a rare condition. It is usually associated with surgeries in the uterus as secondary consequences, and can cause sterility or repeated spontaneous abortions. In this blog post we will tell you what Asherman’s syndrome is, its causes and most common symptoms.

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What is Asherman syndrome?

Asherman’s syndrome is a condition in the uterine cavity that is characterized by the formation of scar tissue, that is, by the presence of scars. In turn, these lesions form adhesions or synechiae on the uterus walls, which deform it and can cause it´s size reduction.

Asherman syndrome symptoms

Adhesions and scars in the uterus can cause:

  • Absence of menstrual periods
  • Irregular periods
  • Infertility
  • Repeated miscarriages

While all of these symptoms are related to other uterine conditions, the main clue to Asherman’s syndrome is that they occur suddenly after uterine surgery, such as dilation and curettage.

It is very important to have Asherman’s syndrome diagnosis in order to assess the uterus condition. The extent of the adhesions in the uterus determines the severity of the condition, which can be mild, moderate, or severe.

When the uterine walls are covered with adhesions, the symptoms are very severe and pregnancy can be extremely difficult to achieve. On the other hand, when the adhesions are partially located in small parts of the uterus, they can cause mild discomfort, and even go unnoticed by affected women.

Causes

Asherman’s syndrome is a rare disease, largely related to dilation and curettage procedures. However, pelvic infections that have been complicated by D&C can also cause scar tissue to form in the uterus.

In other cases, tuberculosis infections or schistosomiasis are also associated with Asherman’s syndrome as complications of the disease. However, these are rare infections in the United States.

Asherman’s syndrome treatment

In cases of moderate to severe Asherman’s syndrome, surgery is recommended to cut and remove scar tissue or adhesions and repair the wall of the uterus. In most cases it can be done with a hysteroscopy, a minimally invasive procedure that allows visualizing the cervix and the uterine cavity, in addition to using small instruments for the intervention.

After hysterectomy to remove scar tissue, the uterine cavity must be kept open while it heals so that new adhesion formation can be prevented. For this purpose, the specialist will place a small balloon inside the uterus for several days. Similarly, he might prescribe estrogen intake while the inside of the uterus heals.

In addition to surgical treatment, women affected by Asherman’s syndrome are recommended to join support groups or take psychological therapy, since the stress of the disease and infertility could be more harmful.

Diagnosis

The first visits to the gynecologist may not give the results of the condition since the basic pelvic exam does not reveal Asherman’s syndrome. The condition could even be confused with others such as polycystic ovary syndrome (PCOS) or with polyps, since the symptoms are similar.

Diagnostic tests to detect Asherman syndrome are:

  • Transvaginal ultrasound
  • Hysterosonography
  • Hysterosalpingoclasis
  • Blood tests to detect tuberculosis or schistosomiasis infections

 

Preventive measures

In general, Asherman’s syndrome cannot be prevented, especially when associated with tuberculosis infection or schistosomiasis. However, the risk of this condition should be considered after surgery on the uterus, such as dilation and curettage. In this way the symptoms can be treated in case adhesions form.

Will I be able to get pregnant after a hysterectomy?

Many women are able to achieve their dream of having a baby after having a hysterectomy to treat Asherman’s syndrome. Some require more than one intervention to remove all the scar tissue. The success of the pregnancy largely depends on the severity of the adhesions and the difficulty of treatment.

However, it is important to consider that infertility is not always resolved with the treatment of Asherman’s syndrome, since there may be other factors involved that hinder fertility.

When to visit the specialist?

If you’ve had gynecological surgery and your periods don’t return to normal after 6 months, and you can’t get pregnant after 12 months of unprotected sex, visit a specialist for an assessment.

At The Fertility Center, a fertility clinic,  we have the fertility specialists you need to take care of your feminine health and make your dream of getting pregnant come true. Schedule your assessment appointment through our contact form. We will gladly assist you!
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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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