Definition

"A condition where the uterine walls adhere to one another, usually caused by uterine inflammation."  In most cases, Asherman's is caused by an overly aggressive procedure called a D&C, which is performed following a miscarriage, birth or for evaluation of the uterus. 

Asherman's can also result from intrauterine surgery to remove fibroids, uterine structural defects (septum, bicornuate uterus, large polyps), or at cesarean section infections related to IUD use (or the placement of any foreign object within the uterine cavity).

In rare cases, other infections or radium insertion into the uterus for the treatment of gynecologic cancers can lead to Asherman's Syndrome.

Symptoms

• No menstrual flow (amenorrhea) or decreased menstrual flow
• Infertility
• Recurrent miscarriages

These symptoms are more likely to indicate Asherman's syndrome if they occur suddenly after a D and C or other uterine surgery.

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 and it maybe necessary to consult an infertility specialist.

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.

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

Source: SeattleInsider.com / Adam.com, Inc. / Illustrated Health Encyclopedia

Research Articles
- Gynecologic surgery and adhesion prevention. Asherman's syndrome.
- Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility.
- Asherman's syndrome: a review of the literature, and a husband and wife's 20-year world-wide experience.
- SprayGel following surgery for Asherman's syndrome may improve pregnancy outcome.
- The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae
- Effectiveness of autocrosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery

- Efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel in prevention of intrauterine adhesions after hysteroscopic surgery
- The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms

Organizations
- International Asherman's Association

Photos
For a compendium of photographs from a Google search of intrauterine adhesions, click here

Videos
- Dr. March - Hysteroscopy: Lysis of Adhesion
- Asherman's Syndrome Specialist, Mr. Lower: Interview 4

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