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Asherman syndrome

Uterine synechiae; Intrauterine adhesions; Infertility - Asherman

Asherman syndrome is the formation of scar tissue in the uterine cavity. The problem most often develops after uterine surgery.

Causes

Asherman syndrome is a rare condition. In most cases, it occurs in women who have had several dilatation and curettage (D&C) procedures.

A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome.

Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States. Uterine complications related to these infections are even less common.

Symptoms

The adhesions may cause amenorrhea (lack of menstrual periods), repeated miscarriages, and infertility.

However, such symptoms could be related to several conditions. They are more likely to indicate Asherman syndrome if they occur suddenly after a D&C or other uterine surgery.

Exams and Tests

A pelvic exam does not reveal problems in most cases.

Tests may include:

Treatment

Treatment involves surgery to cut and remove the adhesions or scar tissue. This can most often be done with hysteroscopy, which uses small instruments and a camera placed into the uterus through the cervix.

After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent adhesions from returning. Your health care provider may place a small balloon inside the uterus for several days. You may also need to take estrogen while the uterine lining heals.

You may need to take antibiotics if there is an infection.

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems.

Outlook (Prognosis)

Asherman syndrome can be cured with surgery. Sometimes more than one procedure will be necessary.

Women who are infertile because of Asherman syndrome may be able to have a baby after treatment. Successful pregnancy depends on the severity of Asherman syndrome and the difficulty of the treatment. Other factors that affect fertility and pregnancy may also be involved.

Possible Complications

Complications of hysteroscopic surgery are uncommon. When they occur, they may include bleeding, perforation of the uterus, and pelvic infection.

In some cases, treatment of Asherman syndrome will not cure infertility.

When to Contact a Medical Professional

Call your provider if your menstrual periods do not return after a gynecologic or obstetrical procedure. See a specialist for an infertility evaluation if you cannot get pregnant after 6 to 12 months of trying.

Prevention

Most cases of Asherman syndrome cannot be predicted or prevented.

References

Benacerraf BR, Goldstein SR, Groszmann YS. Scarred uterus and Asherman's syndrome. In: Benacerraf BR, Goldstein SR, Groszmann YS, eds. Gynecologic Ultrasound: A Problem-Based Approach. Philadelphia, PA: Elsevier Saunders; 2014:chap 177.

Katz VL. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2012:chap 18.

Simpson JL, Jauniaux ERM. Early pregnancy loss and stillbirth. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 27.

    • Uterus

      Uterus - illustration

      The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

      Uterus

      illustration

    • Normal uterine anatomy (cut section)

      Normal uterine anatomy (cut section) - illustration

      The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

      Normal uterine anatomy (cut section)

      illustration

      • Uterus

        Uterus - illustration

        The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

        Uterus

        illustration

      • Normal uterine anatomy (cut section)

        Normal uterine anatomy (cut section) - illustration

        The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

        Normal uterine anatomy (cut section)

        illustration

      Review Date: 5/16/2016

      Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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