Asherman Syndrome - Causes, Symptoms, Diagnosis and Treatment

What Is Asherman Syndrome?

Asherman syndrome, also known as intrauterine synechiae, uterine synechiae, or intrauterine adhesions, is a rare and acquired disorder in women. In this condition, scar tissues, also known as adhesions, form inside the uterus.

These scar tissues can bind to each other and reduce the volume of the uterine cavity. This scar formation and subsequent bonding occur mostly after a uterine surgical procedure as a complication. Rarely due to infections and other factors does Asherman syndrome occur. There is treatment available to treat this condition, which is discussed towards the end.

What Signs and Symptoms Does Asherman Syndrome Cause?

• Women with Asherman syndrome experience no menstrual blood flow (amenorrhea) or less than normal blood flow (hypomenorrhea). Based on the severity of their symptoms, they can also have mild to severe abdominal pain and cramping.

• Such women may have problems getting pregnant. They have infertility issues.

• Even if they get pregnant, they encounter repeated miscarriages.

• Also, some women can have Asherman syndrome and have no symptoms and can have regular periods.

Based on how extensively the adhesions are present, the syndrome can be mild, moderate, or severe.

What Causes Asherman Syndrome in Women?

• Asherman syndrome is most commonly found to occur after surgical manipulation of the uterus, such as after a dilatation and curettage (D and C) procedure. Women who undergo D and C after a miscarriage is at an increased risk of Asherman syndrome.

• D and C to treat other uterine conditions such as heavy menstrual bleeding due to uterine cysts, removing retained placenta after childbirth, and medical termination of pregnancy increases the risk.

• Women who underwent uterine surgeries to remove fibroids, uterine polyps, etc., can also develop uterine scars and adhesions.

• Parasitic infection of the uterus.

• Genital tuberculosis.

• Endometriosis.

• Schistosomiasis.

The more D and C procedure a woman undergoes, the elevated is the risk of developing uterine adhesions.

How Does Asherman Syndrome Affect a Woman’s Ability to Conceive?

Since the scars in the uterine wall bond to each other, the uterine cavity volume decreases. The endometrium becomes deficient, and blood supply gets reduced. Subsequently, they experience difficulty conceiving, and even if they conceive, recurrent abortions can occur.

In women who have successfully crossed their second trimester, it can increase the risk of placenta previa and placenta increta. At times there are chances for stillbirth. Surgical treatments are available, which can increase your chance of conceiving without any subsequent pregnancy complications.

What Other Conditions Can Cause Symptoms Similar to Asherman Syndrome?

If you have the symptoms of Asherman syndrome, do not reach a conclusion that it might be that. Several other conditions, too, can cause similar symptoms. They are,

• Polycystic ovarian syndrome (PCOD).

• Endometriosis.

• Pelvic inflammatory disease (PID).

• Primary and secondary amenorrhea.

How Can Asherman Syndrome Be Diagnosed?

1) Hysteroscopy - The best and most preferred method to confirm Asherman syndrome is hysteroscopy. In this procedure, a specialized instrument called a hysteroscope is inserted into your uterus. This instrument has a camera tool at its end which captures the view inside the uterus. The intrauterine visuals can be simultaneously watched on a digital screen in real-time. If any adhesions happen to exist, the hysteroscopy clearly points it out. But the downside is that most gynecologists do not have them readily available.

2) Hysterosalpingography - Even assessing the shape and size of the uterus can reveal Asherman syndrome. A procedure called hysterosalpingography is done to assess the condition. In this, a contrast fluid will be administered into the uterus, and subsequent X-rays will be taken. These are special forms of X-rays known as fluoroscopy.

Apart from these diagnostic methods, other imaging techniques like MRI (magnetic resonance imaging) and CT (computed tomography) are of limited use as they do not detect Asherman syndrome effectively.

What Treatments Are Available for Asherman Syndrome?

Treatment aims to restore your uterus’ size and shape. Your doctor might not suggest surgical treatment for Asherman syndrome if you are not planning to conceive or have no pain. However, it is based on your health condition, whether or not you need treatment.

Hysteroscope-guided surgery to remove these adhesions with cutting instruments is the suggested treatment method. Following the successful removal of these uterine scars, doctors recommend oral or transdermal or injectable estrogen to prevent further scarring and regenerate the endometrium. Hyaluronic acid application at the operated site also proves beneficial in preventing re-adhesion.

Foley’s catheter or uterine balloon stent is inserted into the uterus for five days post-surgery to prevent re-adhesion.

After one or two weeks of surgery, you need to go for regular follow-ups to monitor your uterus’ condition closely and prevent or pick any minor adhesions. If present, they will be excised when identified.

Conclusion

Some women fail to seek medical help for Asherman syndrome as they remain unaware of it. They think that their menstrual symptoms are due to some less serious conditions. At times, even physicians fail to recognize the condition as the symptoms of this syndrome coincide with several other conditions, and routine pelvic ultrasounds cannot pick out adhesions. Hence, awareness of this condition among women, along with proper diagnostic techniques, is necessary.