Asherman’s Syndrome: Causes, Symptoms, Diagnosis, and Treatment Options

The human body is a remarkable system that works in perfect coordination and assures our good health. Things, however, do not go as planned, and some illnesses may change how the body reacts. Some of these problems can complicate reproductive health issues in women currently trying to conceive.

Disorders of the uterus may present with symptoms of pelvic pain, irregular or scanty ovulation, and difficulties conceiving. Most people will hardly even notice that something has gone wrong until a woman has difficulty conceiving or begins to note unusual monthly deviations. Asherman’s syndrome presents a condition that can form scar tissue within the uterus.

What is Asherman’s Syndrome?

When scar tissue forms in the uterus and/or cervix, this condition can be aptly termed Asherman syndrome, intrauterine adhesions, or intrauterine synechiae. For the most part, these adhesions could occur as the result of surgery on the uterus or dilation and curettage procedures performed.

The present exercise discusses how the interprofessional team can provide better care to patients with Asherman’s syndrome and assess and treat the illness itself. 5 to 39% of women who experience repeated miscarriages have this disease. Women who are not attempting to conceive may not be aware of Asherman syndrome since they may not be concerned about the symptoms or recognise them.

Causes and Risk Factors

Causes

Scar tissue that develops inside the uterus, frequently because of medical treatments, causes Asherman’s Syndrome. Dilation and curettage (D&C) are the most frequent causes, particularly following an abortion, miscarriage, or postpartum difficulties. Radiation therapy for cancer treatment, severe pelvic infections including endometritis, and uterine procedures like fibroid excision or cesarean sections are additional causes.

Risk Factors

Asherman’s Syndrome is more likely to occur in those who have certain characteristics. Women who have had prior uterus surgeries, a history of uterine infections, or multiple D&C procedures are at a higher risk. The risk may also increase if postpartum complications need surgery.

Common Symptoms and Complications

Symptoms

• The most common sign of Asherman syndrome is irregular menstruation. When your period is due, you might also feel pain, but there won’t be any blood. Periods can be very light or irregular, or you may have no periods at all.
• During your period, you may feel pain in your lower abdomen.
• Infertility may result from scar tissue that hinders an egg’s ability to implant in the uterus.
• Scar tissue may increase your chances of miscarriage even if you are able to conceive.
• The size of the scar tissue can affect how severe the symptoms are. There could not be any symptoms at all in certain situations.

Complications

Asherman’s Syndrome can cause several issues, most notably those related to fertility and menstrual health. Because the uterine lining is scarred, many women have mild or no periods. This may result in repeated miscarriages and make it harder to conceive. The scar tissue may occasionally result in irregular cramping or pelvic pain. Severe adhesions can obstruct menstrual blood flow, resulting in hematometra, a painful and infected condition, if treatment is not received. Additionally, women with a history of Asherman’s Syndrome are more likely to experience pregnancy issues such as placenta previa or preterm labour.

Diagnostic Methods

The first step in diagnosing Asherman’s Syndrome usually involves reviewing the patient’s medical history and symptoms, particularly if the woman has had light or no periods following a uterine operation.

By directly viewing the uterine cavity and determining the degree of adhesions, a hysteroscopy is the most effective diagnostic procedure. Other techniques include hysterosalpingography (HSG), an X-ray that highlights the uterine shape with contrast dye, and sonohysterography, which involves injecting saline into the uterus prior to an ultrasound to identify abnormalities. A 3D pelvic ultrasound can be useful in detecting scarring, although it is not as accurate as other techniques.

Treatment Options

There are various approaches to treating Asherman’s Syndrome. Discuss your feelings, any pain you may be experiencing, and your fertility objectives with your healthcare professional. If you don’t have any symptoms, you might be able to do nothing. However, there are procedures that remove scar tissue and increase your chances of getting pregnant. If you have pelvic pain or cramps, treatment for Asherman’s Syndrome may also be helpful.

Hysteroscopic surgery is the most often used treatment for Asherman’s Syndrome. Surgeons use a tool to remove adhesions from the uterine wall during this surgery. The repair and regeneration of uterine cells may be facilitated by hormonal treatments.

Antibiotics may reduce infection and inflammation following hysteroscopic surgery, but they do not directly treat Asherman’s Syndrome. A physician might advise putting in a uterine balloon stent or a Foley catheter to keep the uterus walls apart to avoid scar tissue accumulation.

Impact on Fertility and Pregnancy

Pregnancy and fertility can be severely impacted by Asherman’s Syndrome. Infertility may result from uterine scar tissue that inhibits implantation. The chance of miscarriage, preterm labour, and placental problems such as placenta previa or accreta increases if pregnancy develops.

In extreme situations, the uterus might not grow appropriately, raising pregnancy risks. By repairing the uterine lining, treatments like hysteroscopic surgery can enhance reproductive results. Some women can still experience difficulties, though, and need reproductive therapies. The likelihood of a healthy reproductive system and a successful pregnancy are increased by early diagnosis and appropriate treatment.

Preventive Measures

Minimising uterine damage and lowering the chance of scarring are key components in preventing Asherman’s Syndrome. Avoiding needless dilatation and curettage (D&C) whenever feasible can be beneficial, particularly following an abortion or miscarriage. If a D&C is required, the danger may be reduced by employing softer techniques such as suction or medical treatment rather than harsh curettage.

To avoid adhesions, doctors may advise hormone therapy or the implantation of a balloon catheter following uterine surgery. Reducing scarring also depends on treating uterine infections as soon as possible. Following surgery or an infection, routine checkups can help identify and treat any problems early on, enhancing fertility and reproductive health.

Conclusion

Pregnancy, fertility, and menstrual health can all be impacted by Asherman’s Syndrome, although results can be improved with early detection and appropriate care. Many women can regain their reproductive health and have healthy pregnancies with prompt medical attention and preventative measures. To avail of additional information, you can visit the Oasis Fertility Clinic near you. You can also engage with us using the live chat facility or call us at 1800-3001-1000 for prompt assistance.

Frequently Asked Questions (FAQs)

1. Can Asherman’s Syndrome go away on its own?

No, without medical assistance, the scar tissue does not go away. Normal uterine function needs to be restored by treatment.

2. Is Asherman’s Syndrome Painful?

While some women may not feel any pain at all while having adhesions, others may have pelvic pain or cramps.

3. Can Asherman’s Syndrome return after treatment?

Adhesions can, in fact, occasionally reform, which is why follow-ups and preventative actions are crucial.