Asherman Syndrome - Causes, Symptoms, Diagnosis and Treatment

What Is Asherman Syndrome?

Asherman syndrome, also known as intrauterine synechiae, uterine synechiae, or intrauterine adhesions, is a rare and acquired disorder in women. In this condition, scar tissues, also known as adhesions, form inside the uterus.

These scar tissues can bind to each other and reduce the volume of the uterine cavity. Scar formation and subsequent bonding occur mostly after a uterine surgical procedure as a complication. Rarely, due to infections and other factors, does Asherman syndrome occur. Treatment is available to treat this condition, which is discussed towards the end.

What Signs and Symptoms Does Asherman Syndrome Cause?

• Women with Asherman syndrome experience no menstrual blood flow (amenorrhea) or less than normal blood flow (hypomenorrhea). Based on the severity of their symptoms, they can also have mild to severe abdominal pain and cramping.

• Such women may have problems getting pregnant. They have infertility issues.

• Even if they get pregnant, they encounter repeated miscarriages.

• Also, some women can have Asherman syndrome without symptoms and have regular periods.

The syndrome can be mild, moderate, or severe, depending on the prevalence of adhesions.

Who Is Susceptible to Asherman Syndrome?

Since Asherman syndrome is an acquired disorder, scar tissue normally develops due to an external event. Asherman syndrome can develop as a result of many medical procedures, infections, and cancer therapies.

Asherman syndrome may be more likely to strike if one has

• Previously undergone uterine surgery, such as an operational hysteroscopy, a complex dilatation, and curettage (D and C), or a cesarean section (c-section).

• Pelvic infections in the past.

• Undergone cancer treatment.

What Causes Asherman Syndrome in Women?

• Asherman syndrome is most commonly found to occur after surgical manipulation of the uterus, such as after a dilatation and curettage (D and C) procedure. Women who undergo D and C after a miscarriage are at increased risk of Asherman syndrome.

• D and C to treat other uterine conditions such as heavy menstrual bleeding due to uterine cysts, removing retained placenta after childbirth, and medical termination of pregnancy increase the risk.

• Women who underwent uterine surgeries to remove fibroids, uterine polyps, etc., can also develop uterine scars and adhesions.

• Parasitic infection of the uterus.

• Genital tuberculosis (a kind of tuberculosis affecting reproductive organs).

• Endometriosis (a frequent disorder when tissue that resembles the uterine lining develops on other bodily regions).

• Schistosomiasis (a parasitic disease).

The more D and C procedures a woman undergoes, the higher the risk of developing uterine adhesions.

How Does Asherman Syndrome Affect a Woman’s Ability to Conceive?

Since the scars in the uterine wall bond to each other, the uterine cavity volume decreases. The endometrium becomes deficient, and the blood supply is reduced. Subsequently, they experience difficulty conceiving, and even if they conceive, recurrent abortions can occur.

In women who have successfully crossed their second trimester, it can increase the risk of placenta previa and placenta increta. At times, there are chances for stillbirth. Surgical treatments are available, which can increase the chance of conceiving without any subsequent pregnancy complications.

What Other Conditions Can Cause Symptoms Similar to Asherman Syndrome?

If women have the symptoms of Asherman syndrome, do not conclude that it might be that. Several other conditions, too, can cause similar symptoms.

They are,

• Polycystic ovarian syndrome (PCOD).

• Endometriosis.

• Pelvic inflammatory disease (PID).

• Primary and secondary amenorrhea.

Can One Become Pregnant After Receiving Asherman Syndrome Treatment?

Receiving treatment for Asherman's syndrome may often lead to a successful conception. Because it is not always simple to identify the cause, infertility might be difficult to treat. Treating Asherman syndrome may increase the likelihood of becoming pregnant and delivering a healthy child if the physician has determined that it is the primary cause of infertility.

How Can Asherman Syndrome Be Diagnosed?

1) Hysteroscopy—Hysteroscopy is the best and most preferred method to confirm Asherman syndrome. In this procedure, a specialized instrument called a hysteroscope is inserted into the uterus. This instrument has a camera tool at its end that captures the view inside the uterus. The intrauterine visuals can be simultaneously watched on a digital screen in real-time. If any adhesions happen to exist, the hysteroscopy clearly points them out. However, the downside is that most gynecologists need to have them readily available.

2) Hysterosalpingography—Even assessing the shape and size of the uterus can reveal Asherman syndrome. A procedure called hysterosalpingography is performed to assess the condition. In this, contrast fluid is administered into the uterus, and subsequent X-rays are taken. These are special forms of X-rays known as fluoroscopy.

Apart from these diagnostic methods, other imaging techniques like MRI (magnetic resonance imaging) and CT (computed tomography) are of limited use as they need to detect Asherman syndrome effectively.

What Treatments Are Available for Asherman Syndrome?

Treatment aims to restore the uterus’ size and shape. The doctor might not suggest surgical treatment for Asherman syndrome if individuals are not planning to conceive or have no pain. However, it is based on the health condition and whether or not one needs treatment.

Hysteroscope-guided surgery to remove these adhesions with cutting instruments is the suggested treatment method. Following the successful removal of these uterine scars, doctors recommend oral, transdermal, or injectable estrogen to prevent further scarring and regenerate the endometrium. Hyaluronic acid application at the operating site also proves beneficial in preventing re-adhesion.

Foley’s catheter, or uterine balloon stent, is inserted into the uterus for five days post-surgery to prevent re-adhesion.

After one or two weeks of surgery, regular follow-ups are necessary to monitor the uterus’ condition closely and prevent or pick up any minor adhesions. If present, they will be excised when identified.

Can One Avoid Asherman Syndrome?

The scar tissue associated with Asherman syndrome may result from several different medical treatments. This is frequently unavoidable since it requires a medical procedure. Whenever feasible, discussing any potential risks associated with a medical procedure in advance with a medical professional is essential. Following a procedure, the doctor could arrange follow-up visits to look for scar tissue and monitor potential Asherman syndrome development.

Conclusion

Some women fail to seek medical help for Asherman syndrome because they remain unaware of it. They think that their menstrual symptoms are due to less serious conditions. At times, even physicians fail to recognize the condition, as the symptoms of this syndrome coincide with several other conditions, and routine pelvic ultrasounds cannot pick out adhesions. Hence, awareness of this condition among women and proper diagnostic techniques are necessary.