What is Asherman Syndrome and What Are Its Symptoms?
Asherman syndrome is a rare, non-genetic condition characterized by the formation of scar tissue in the uterus or cervix. This scarring reduces the functional space of the uterus, leading to menstrual irregularities, pelvic pain, and infertility.
Asherman syndrome typically occurs due to trauma or inflammation, often as a result of uterine surgery or infection. The adhesions formed by scar tissue can significantly impact fertility and menstrual health.
Keep reading to learn more about the symptoms and causes of Asherman syndrome.
Causes of Asherman Syndrome
The most common cause of Asherman syndrome is dilation and curettage (D&C) performed after a miscarriage or childbirth. This procedure involves dilating the cervix and scraping the uterine lining with a curette, which can sometimes trigger scar tissue formation.
Other causes of Asherman syndrome include:
- Operative hysteroscopy for removing fibroids or polyps
- Cesarean sections
- Inflammatory conditions like endometriosis, cervicitis, or pelvic inflammatory disease (PID)
- Radiation therapy for cervical cancer
- Infections, such as genital tuberculosis, particularly in developing countries
Asherman Syndrome Symptoms
Asherman syndrome typically presents with the following symptoms:
Menstrual Irregularities
Women with Asherman syndrome often experience little to no menstrual bleeding (hypomenorrhea or amenorrhea). The scar tissue adds bulk to the uterine walls, leading to irregular shedding or blocking the uterine cavity, thus cutting off blood flow.
Pelvic Pain or Cramps
Severe cramps and pelvic pain are common in advanced cases of Asherman syndrome. When the uterus or cervix is largely adhered together, blood flow may be partially or completely obstructed, causing debilitating pain.
Infertility or Recurrent Miscarriage
The scar tissue makes it difficult for embryos to implant and grow, resulting in infertility or repeated miscarriages.
Retrograde Menstrual Flow
In cases where adhesions completely block the uterus or cervix, menstrual blood may flow backward into the abdominal cavity, leading to retrograde menstruation.
Asherman Syndrome and Pregnancy
Some people wonder whether there is a problem between Asherman syndrome and pregnancy. Asherman syndrome may lead to infertility or miscarriage. The adhesions narrow the uterine or cervical cavity, making implantation of the embryo or the normal growth of a fetus difficult.
Pregnant women with Asherman syndrome are at higher risk of placental abnormalities, such as placenta accreta. Severe adhesions can make implantation nearly impossible, leading to infertility.
Diagnosis of Asherman Syndrome
Asherman syndrome is diagnosed through clinical evaluation and imaging techniques.
Clinical Evaluation
Women with symptoms like pelvic pain, absent or irregular periods, infertility, or recurrent miscarriage, especially after uterine surgeries like D&C, C-section, or hysteroscopy, should be evaluated for Asherman syndrome.
Imaging Methods
- Ultrasound: Both transabdominal and transvaginal ultrasounds are used to visualize the uterus and detect adhesions.
- Hysteroscopy: A small camera is inserted through the cervix to directly view the uterine cavity.
- Saline Infusion Sonography (SIS): Ultrasound combined with a saline solution provides clearer imaging of the uterine cavity, allowing for detailed evaluation of adhesions.
Asherman Syndrome Treatment
Treatment for Asherman syndrome depends on the severity of the adhesions and the patient’s symptoms.
- Mild Cases: Women who do not experience pain or discomfort and have no pregnancy plans may not require treatment.
- Surgical Intervention: A hysteroscope is used to carefully cut and remove adhesions. Surgery is often followed by hormonal therapy (estrogen) to prevent reformation of scar tissue.
- Post-Treatment Care: Treatment can alleviate pain, restore normal menstruation, and improve the chances of a successful pregnancy.
