Intrauterine adhesions that typically occur as a result of scar formation after uterine surgery, especially after a dilatation and curettage ( D and C ). The adhesions may cause amenorrhea and/or infertility.
Causes, incidence, and risk factors
Asherman's syndrome is an uncommon problem. It most often occurs after a D and C is performed, but it can also occur after other types of uterine surgery. It may be more likely to happen after a pregnancy-related D and C, or if an infection is present in the uterus during the time of the procedure. A severe pelvic infection unrelated to surgery may also lead to Asherman's syndrome. Intrauterine adhesions can also form after infection with tuberculosis (the bacteria that causes TB) or schistosomiasis (a parasite). These infections are rare in the United States, and uterine complications such as Asherman's syndrome related to these infections are even rarer.
Signs and tests
A pelvic exam is usually normal. If Asherman's syndrome is suspected, your doctor may recommend a hysterosalpingogram (an X-ray test of the uterine cavity) or hysteroscopy (an outpatient surgical procedure). During hysteroscopy, a small camera is inserted through the cervix that allows your doctor to look at the inside of your uterus under magnification. These tests may reveal scar tissue partially or completely filling the uterine cavity. If infertility is a problem, other tests or evaluations may be recommended. Lab tests that detect tuberculosis or schistosomiasis may be recommended if these infections are suspected.
Treatment
Asherman's syndrome should be treated if it is causing infertility or amenorrhea. Surgical treatment includes cutting and removing adhesions or scar tissue within the uterine cavity. This can usually be performed by hysteroscopy -- small instruments and a camera are placed into the uterus through the cervix. After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent recurrence of the adhesions. Your doctor may place a small balloon inside the uterus for several days, and may prescribe estrogen replacement therapy to take for several months while the uterine lining heals. If tuberculosis or schistosomiasis infections are detected, antibiotic treatment will be necessary.
Expectations (prognosis)
Asherman's syndrome can be cured in most women with surgery, although sometimes more than one procedure will be necessary. Approximately 70-80% of women who are infertile because of Asherman's syndrome will have a successful pregnancy after treatment.
Complications
Complications of hysteroscopic surgery include bleeding, perforation of the uterus and pelvic infection, although these are uncommon. In some cases, treatment of Asherman's syndrome will not cure infertility.
Calling your health care provider
Call your health care provider if your menstrual periods do not resume after a gynecologic or obstetrical procedure. An evaluation for infertility is also warranted if you are unable to achieve a pregnancy after 6 to 12 months of trying.
Prevention
Asherman's syndrome may be less common if prophylactic antibiotic treatment is given when a D and C is performed, but most cases of Asherman's syndrome cannot be predicted or prevented.