There are a plethora of female health conditions that can affect fertility and menstruation. One such condition is Asherman’s syndrome. Asherman’s syndrome is a significant condition that is characterised by a damaged uterine lining. This article will shed light on this rare syndrome by discussing its causes, symptoms, diagnosis and treatment methods. This article will also feature an important FAQ section to cover the most common queries surrounding this condition.
Asherman’s syndrome can be characterised as a rare and complex condition in which scar tissue, known as intrauterine adhesions or uterine synechiae, forms inside the uterus. This thick fibrous tissue can accumulate in the uterus, causing pelvic pain and abnormal uterine bleeding. As the disease progresses, fertility problems and other complications can arise. Fibrous tissue often develops as a result of trauma or injury within the uterine lining, most commonly forming after specific surgical procedures. Although this syndrome can have life-long consequences, treatments are available to help relieve symptoms and manage pain.1
Causes of asherman's syndrome
The predominant cause of Asherman’s syndrome is trauma or injury localised at the uterine lining. Damage can be caused by:
- Caesarean Section: People assigned female at birth (AFAB) who have had multiple caesarean deliveries may have an increased risk of developing Asherman's Syndrome
- Uterine Surgery: Any type of surgical intervention performed on the uterus, such as myomectomy or hysteroscopic metroplasty, can potentially result in the development of Asherman's Syndrome
- Dilatation and Curettage (D&C): This procedure involves the scraping or suctioning of the uterine lining to remove any excess tissue or debris. The procedure is often required after an abortion, a miscarriage, or to remove retained placental tissue after birth1
Signs and symptoms of asherman's syndrome
The signs and symptoms of Asherman's syndrome can vary from mild to severe, with some patients not experiencing any symptoms at all. Some of the most common symptoms include:
- Abnormal menstrual bleeding, which includes having very light periods (hypomenorrhea), irregular periods (oligomenorrhea), or not having a period (amenorrhea) at all
- Severe cramps and pelvic pain due to the presence of scar tissue
- Having difficulty getting pregnant or staying pregnant as Asherman's syndrome can interfere with the implantation process of a fertilised egg, resulting in multiple recurrent miscarriages2
Diagnosis of asherman's syndrome
The diagnosis of Asherman’s syndrome is not always easy as many of the signs and symptoms of the condition can overlap with other conditions.To correctly and efficiently diagnose this syndrome, a range of diagnostic techniques may be used. These include:
- A full medical history and symptom assessment: This will entail an in-depth evaluation of the patient's medical history to identify the signs and symptoms that they may be experiencing
- Transvaginal ultrasound: This is a vital imaging technique that can be used to aid in the detection of abnormalities within the uterine cavity and evaluate the extent of the scar tissue and adhesions formation
- Hysteroscopy: This is a minimally invasive procedure that allows direct visualisation of the uterine cavity using a hysteroscope, enabling identification and characterisation of any adhesions that may be detected
- Hysterosalpingography: This diagnostic test involves injecting a contrast dye into the uterus and taking X-ray images to detect abnormalities in the uterine cavity4
Management and treatment for asherman's syndrome
The management and treatment of Asherman’s syndrome is highly dependent on the severity of the condition. Different methods may be used to appropriately manage the symptoms of the patient, including:
- Hysteroscopic adhesiolysis: This procedure involves the removal, or separation, of adhesions within the uterine lining using specialised instruments under hysteroscopic guidance
- Hormone therapy: Oestrogen therapy works alongside adhesiolysis as a means to promote the regrowth of the uterine lining and to prevent the reformation of scar tissue or abnormal adhesions
- Serial hysteroscopy: Increased and regular monitoring of the uterine lining with hysteroscopy after initial treatment methods may aid in detecting and managing any recurrent adhesions
- Assisted reproductive techniques: In cases where Asherman's syndrome has resulted in infertility, assisted reproductive methods such as in-vitro fertilisation (IVF) may be recommended to promote a healthy pregnancy3
How can I prevent asherman's syndrome?
As Asherman’s syndrome is caused by trauma and injury following medical procedures, there is often little that can be done to prevent it as these medical procedures are necessary to save a patient’s life in the majority of cases. However, it is important to have a discussion with your healthcare provider about the necessity and the risks of any given medical procedure. Your care team may also schedule a follow-up appointment to check for any scar tissue post-surgery in order to provide early interventions if Asherman’s syndrome is suspected.5
Who is at risk of asherman's syndrome?
Asherman’s syndrome is a condition that develops as a result of injury, therefore there are no specific factors that may increase your risk of developing the condition. However, there are people who may be more prone to experiencing damage to their uterine lining:
- People who have had previous surgery that may have caused trauma or injury at the site of the uterine lining
- People who have a history of pelvic infections
- People who have been previously treated for cancer6
How common is asherman's syndrome?
Asherman’s syndrome is considered to be rare, mainly due to the fact that it has a high chance of being left undiagnosed. It is difficult to estimate how many people live with the condition as many never even experience any symptoms that may prompt them to seek medical help.7
When should I see a doctor?
You should see a doctor regarding Asherman’s syndrome if you experience any of the signs and symptoms mentioned above, such as pelvic pain, infertility issues and abnormal bleeding. If you have had any recent surgical procedures that were performed on the uterus, such as a caesarean section, having follow-up appointments with your doctor may help to detect Asherman’s syndrome early on.8
Asheman’s syndrome is a rare female reproductive health condition that can lead to abnormal menstruation and infertility. It is caused by injury to the uterine lining following common surgical procedures performed on the uterus, such as caesarean section and dilatation. Early diagnostic measures, as well as appropriate and effective management, are essential in restoring uterine function and maximising reproductive health. By increasing awareness and pushing for research advancements in this field, we can help affected individuals overcome the challenges of living with Asherman’s syndrome, optimising their reproductive health and improving their general well-being.
- March CM. Asherman’s Syndrome. Semin Reprod Med [Internet]. 2011 [cited 2023 May 18]; 29(2):83–94. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0031-1272470.
- Klein SM, García CR. Asherman’s syndrome: a critique and current review. Fertil Steril. 1973; 24(9):722–35. https://pubmed.ncbi.nlm.nih.gov/4725610/
- Salazar CA, Isaacson K, Morris S. A comprehensive review of Asherman’s syndrome: causes, symptoms and treatment options. Current Opinion in Obstetrics and Gynecology [Internet]. 2017 [cited 2023 May 18]; 29(4):249. Available from: https://journals.lww.com/co-obgyn/Abstract/2017/08000/A_comprehensive_review_of_Asherman_s_syndrome_.10.aspx.
- March CM. Management of Asherman’s syndrome. Reproductive BioMedicine Online [Internet]. 2011 [cited 2023 May 18]; 23(1):63–76. Available from: https://www.sciencedirect.com/science/article/pii/S1472648310007844.
- Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reproductive Biology and Endocrinology [Internet]. 2013 [cited 2023 May 18]; 11(1):118. Available from: https://doi.org/10.1186/1477-7827-11-118.
- Yu D, Wong Y-M, Cheong Y, Xia E, Li T-C. Asherman syndrome—one century later. Fertility and Sterility [Internet]. 2008 [cited 2023 May 18]; 89(4):759–79. Available from: https://www.sciencedirect.com/science/article/pii/S0015028208003634.
- Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N. Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman’s syndrome. Arch Gynecol Obstet [Internet]. 2010 [cited 2023 May 18]; 281(2):355–61. Available from: https://doi.org/10.1007/s00404-009-1117-x.
- Myers EM, Hurst BS. Comprehensive management of severe Asherman syndrome and amenorrhea. Fertility and Sterility [Internet]. 2012 [cited 2023 May 18]; 97(1):160–4. Available from: https://www.sciencedirect.com/science/article/pii/S001502821102721X.