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Asherman’s Syndrome

A blog by Dr. Alan B. Copperman, RMA of New York, July 8, 2015

Asherman’s Syndrome is a condition that describes scarring in the uterine cavity. Asherman’s can result from nearly any uterine procedure. Commonly, the scar tissue or “intrauterine synechiae” results from a dilatation and curettage (D&C) to remove the contents of a miscarriage or following a delivery, it can also follow a postpartum infection, pelvic inflammatory disease, radiation treatment of the pelvis, and uterine surgery for the removal of fibroids. While Asherman’s syndrome classically presents with light or absent menses, some patients may experience monthly pain and/or infertility.

Asherman’s Syndrome was named for an Israeli gynecologist who wrote extensively about the trauma that he saw in women who had undergone curettage. Asherman’s is characterized by the sudden onset of menstrual irregularities after the surgery, with women noting that their periods either became extremely light or ceased completely. Because the condition is only seen following a relatively small percentage of D & C’s, many doctors are unfamiliar with it and it is not always immediately diagnosed. A confirmed diagnosis only takes place following a hysterosalpingogram or saline sonogram, which uses x-ray or ultrasound to monitor the path of fluid injected into the uterus.

The emotional impact of Asherman’s Syndrome is particularly difficult for those who had a dilation and curettage following miscarriage, as not only was there an initial loss of pregnancy, but the aftermath can make it extremely difficult to conceive or carry a pregnancy again in the future. Treatments depend upon the severity of the condition, and can include surgical removal of adhesions followed by hormone treatments designed to encourage the regrowth of the endometrial lining. Following surgical correction, women are often able to become pregnant. In cases where the endometrium has been damaged down to the basal layer, the lining of the uterus or endometrium may fail to respond to hormonal treatment, and carrying a pregnancy may be challenging.

Following surgical correction of Asherman’s syndrome, women who successfully conceive may still need to be monitored carefully throughout their pregnancy, as they are at a higher risk of placental implantation issues including placenta previa and placenta accreta. Despite the risks and difficulties associated with Asherman’s Syndrome, following surgical correction, many women are able to conceive and carry healthy pregnancies to term.


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