Uterine Adhesions (or) Uterine Scarring (or) Asherman Syndrome

What are intrauterine adhesions?
Asherman syndrome is a condition that is the formation of scar tissue in the uterine cavity. The problem most often develops after uterine surgery. The scarring of the tissue causes thickening, breaking down and bleeding — during each menstrual cycle. This results in an enlarged uterus and painful, heavy periods. Asherman syndrome is a rare condition and mostly occurs in women who have had several dilatation and curettage procedures in the past.

What are the potential causes of Asherman syndrome?
Most cases of Asherman’s syndrome is caused by a past uterine surgery such as dilation and curettage while the scarring is also possible with a cesarean section or from sutures used to stop haemorrhages. Other possible causes include – endometriosis, infections of the reproductive organs and past radiation treatment.

What symptoms are associated with Asherman syndrome?
The symptoms of asherman’s syndrome include:

  • Having very light periods
  • Having no periods
  • Having severe cramping or pain
  • Inability to sustain pregnant

How do you make a diagnosis of Asherman syndrome?
Asherman syndrome can be diagnosed by any one of the following diagnostic methods – hysteroscopy, hysterosalpingogram, or saline sonohysterogram – with hysteroscopy being the most accurate and widely deployed. Hysteroscopy is a procedure that allows your doctor to look inside your uterus to diagnose and treat the causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus.

How is Asherman syndrome treated?
The treatment for asherman syndrome is done by a surgical procedure – a hysteroscopy. The objective of the surgery is to make the uterus regain its normal size and shape. In addition to diagnosis, hysteroscopy can also be used to treat the condition by cutting the adhesions with very small scissors, lasers, or other types of instruments that use hooks or electrodes.

Are there any long-term issues of intrauterine adhesions that I need to be concerned about?
In the long term, some of the patients may continue to have difficulty with absent or infrequent periods. It is possible that pregnancies after treatment will be complicated by miscarriage, preterm labour, third-trimester bleeding, and/or abnormal attachment of the placenta to the uterine wall. After treatment, patients with mild-to-moderate adhesions usually experience return of normal menstrual function and have successful full-term pregnancy rates of approximately 70% to 80% of the cases.

How does Asherman syndrome affect fertility?
While it is normal for some women with Asherman syndrome to have difficulties conceiving normally or may have recurrent miscarriages, it is possible to become pregnant. However, the adhesions in the uterus can pose a risk to the developing foetus. Thus, the chances of miscarriage and stillbirth will also be higher than in women without this condition. Patients with mild to moderate uterine adhesions removed have 70 to 80% full-term pregnancy success rates, and menstrual dysfunction is usually alleviated. If the intrauterine adhesions were severe or caused extensive damage to the endometrial lining, full-term pregnancy success rates are only 20 percent to 40 percent after treatment.

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