Did you know that nearly 5-39% of women with recurrent miscarriage issues suffer from Asherman’s syndrome? This syndrome develops as a result of scarring inside the uterus and blocks sperm implantation. While we all know what miscarriages are, let’s understand what is Asherman’s syndrome, its causes, symptoms, and treatment.
What causes Asherman’s Syndrome?
Asherman syndrome develops when scarring inside the uterus turns to scar tissues, blocking its activities. These scar tissues are also known as intrauterine adhesions. They happen after surgeries like D&C (dilation and curettage) and cesarean section. Growing adhesions shrink the uterine cavity. This makes it harder for a fertilized egg to implant. In severe cases, Asherman syndrome causes the uterine walls to even stick together. This stops menstrual bleeding. It can also result in more miscarriages or infertility.
Who can get Asherman’s Syndrome?
Asherman syndrome is a rare condition found in women who undergo uterine treatments. It happens after several D&C (dilation and curettage) surgeries. These are primarily done to remove tissues remaining after miscarriage, abortion, or postpartum issues. Women with a cesarean section or, pelvic surgery, or uterine surgery like hysteroscopy surgery, which involves removal of fibroid or polyp (lumps in the uterine lining that cause heavy menstrual flow), face a greater risk of developing this syndrome. In a few cases, pelvic infections like endometritis can also cause such scarring.
What are the symptoms of Asherman’s Syndrome?
Symptoms of Asherman’s syndrome can be very easy to overlook. Undiagnosed Asherman’s reduces fertility in women permanently. To detect it, look for the following Asherman’s syndrome symptoms:
- Amenorrhea: This means lighter or skipped periods. Intrauterine adhesions or scar tissue congest the uterus, blocking regular menstruation. This is one of the most common cases of Asherman’s syndrome.
- Pelvic Pain: Often known as lower abdomen cramping. It develops when the uterus tries to shed its lining but fails to do so because of adhesions.
- Miscarriages and Infertility: Scars make it harder for a fertilized egg to attach to the uterus properly, resulting in several pregnancy losses.
- Conception Problems: Many women develop Asherman’s syndrome after repeatedly failing to conceive.
Symptoms for this are often mild, and they can be misinterpreted as other menstrual problems. Early detection is important to avoid confusion.
What causes Asherman’s Syndrome?
The reasons for Asherman’s syndrome are mostly linked to uterine trauma or surgical treatments.
- Dilation and Curettage (D&C): 1% of women with many D&Cs or miscarriages or a retained placenta suffer from uterine adhesions.
- Cesarean Section: Scar tissues from a past C-section surgery can trigger intrauterine adhesions.
- Infections of the Uterus: These may happen after delivery or miscarriage. Endometritis and other infections can harm the lining of the uterus.
- Pelvic Surgery: Treatments such as fibroid removal or other uterine anomalies can leave scars in the uterine cavity.
Conditions Associated with Asherman’s Syndrome
Some conditions trigger Asherman’s syndrome in women. This develops as a comorbidity, a simultaneously present condition. They are:
- Endometritis: Soreness in the uterus lining triggers adhesions. Continuous damage to the lining replaces the normal endometrial tissue with fibrous scar tissue. Scar tissues block the walls of the uterus with adhesions.
- Intrauterine Infections: Infections during delivery or miscarriage can injure the uterine lining. This results in scar tissue formation.
- Multiple Uterine Procedures: Recurrent uterine operations such as D&C or fibroid extraction result in adhesions.
- Hormonal Deficiencies: Low estrogen levels restrict the healing process of the uterine lining, which triggers scar tissue development.
How is Asherman’s syndrome diagnosed?
Many treatments exist for Asherman’s syndrome. Some of the most common are:
- Hysteroscopy is the best method for diagnosing Asherman’s syndrome. In this method, a thin tube with a small camera is inserted into the uterus. Doctors check for causes of abnormal bleeding, such as polyps, fibroids, and adhesion. Hysteroscopy can be diagnostic or curative and used for treatments.
- Sonohysterography involves inserting a saline solution into the uterus. Then, ultrasound imaging is used to detect abnormalities.
- In hysterosalpingography (HSG), a dye is injected into the uterus to visualize it. This assesses the shape and any blockages in the uterine cavity and fallopian tubes.
- MRI: This scan creates an extensive picture of the uterus and surrounding tissues. It is used to find scar tissue.
Treatment and Management
Asherman’s syndrome is treated only after a proper diagnosis. There are many surgical options available to remove adhesions and heal the uterine cavity. Asherman’s syndrome treatment options include:
- Hysteroscopic Adhesiolysis: This involves gently cutting and removing scar tissue with a hysteroscope. A hysteroscopy is a narrow, lighted instrument with a camera at the end used to examine the inside of the uterus.
- Hormonal treatment: Oestrogen treatment stimulates the regrowth of the uterine wall after surgery.
- Intrauterine device (IUD): It is inserted in the uterus for 3 months to keep the uterine walls from binding together during the healing process.
Post-surgery treatment includes regular checkups to make sure the uterus heals correctly and is free of adhesions.
Preventing Asherman’s Syndrome
Preventing Asherman’s syndrome mainly includes reducing uterine trauma and promoting proper healing.
- Minimally Invasive Surgery: Removes residual tissues using hysteroscopic surgeries. This has minimal impact on the endometrium.
- Anti-Adhesion Barriers: After surgery, Apply resorbable membranes (used for tissue regeneration) or gels to prevent the uterine wall from blocking while healing.
- Hormonal Support: Use estrogen supplements after surgery to restore menstrual balance to promote endometrial regrowth and fibrosis.
- Early Imaging Surveillance: Two to four weeks after surgery, sonohysterography is used to detect and treat early adhesion formation.
Summary
Asherman’s syndrome is an undiscussed and rare disorder. It results in irregular menstrual flow, repeated miscarriages, and infertility. To increase the chances of a healthy pregnancy and restore uterine function, seek early diagnosis with the right treatment for you. There are many options available now with advancements in technology. With that being said, prevention is always better than cure. Follow prevention tips to avoid blockage of uterine walls.
FAQs
1.How common is Asherman’s syndrome?
Asherman’s syndrome is an uncommon disease. It can go undetected very easily, making it difficult to diagnose. It occurs as a comorbidity with other conditions.
2.Is Asherman’s syndrome genetic?
No, this condition is not genetic. It is a side effect of other conditions and causes scarring in the uterus.
3.Can people prevent Asherman syndrome?
Predicting or preventing cases of Asherman’s syndrome is very difficult. It can go undetected very easily. However, there are various methods to avoid it from happening to you.
4.Can people get pregnant with Asherman syndrome?
Yes, pregnancy is possible even with Asherman’s syndrome. Yet, it increases risks, such as miscarriages, infertility, and pregnancy complications, because of uterine scarring and adhesions.
5.Can Asherman’s syndrome cause infertility?
Yes, it can cause infertility in women. It happens due to uterine scarring, which blocks the walls of the uterus. This blockage makes conception unlikely.
6.Does Asherman’s syndrome cause miscarriage?
Yes, Asherman’s syndrome can lead to miscarriage. This is because scar tissue formation reduces place inside the uterus and also causes issues in the placental attachment of the fetus.
7.What is the triad of Asherman’s syndrome?
Asherman’s syndrome has a triad of symptoms. They include infertility, menstrual abnormalities like amenorrhea or hypomenorrhea, and pelvic pain.