Asherman's Syndrome, or intrauterine adhesions ( scars or synechiae) occurs when adhesions (bands of fibrous scar tissue) form inside the uterus. The extent of the adhesions defines whether the case is mild, moderate or severe. A Grades system is used to classify the severity of the disease.

Symptoms

Most patients with Asherman's have scanty or absent periods (amenorrhea) . The diagnosis is often missed because it cannot be made on routine ultrasound scans.

Causes

Asherman’s syndrome occurs when trauma to the uterine lining ( the endometrium) causes the damaged areas to fuse together. Most commonly, intrauterine adhesions occur after a D&C ( dilatation and curettage)that was performed because of a missed or incomplete miscarriage. It may also occur after a D&C done to treat a retained placenta; or after an elective abortion. Pregnancy-related D&Cs have been shown to account for 90% of Asherman’s cases . Adhesions may also occur following other pelvic surgeries such as cesarean section, myomectomy or as a result of infections such as genital tuberculosis.

There is a variant of Asherman's Syndrome that is more difficult to treat. This is the condition of a "thin endometrium" or endometrial sclerosis. Here the endometrium has been denuded and cannot grow properly.

Diagnosis

The diagnosis is best made by doing a hysteroscopy . Other methods include a HSG in which the adhesions are visualised as filling defects within the uterine cavity.

Treatment

Asherman’s must be treated by a very experienced surgeon via hysteroscopy . Adhesions have a tendency to reform , especially in more severe cases. Re-scarring after surgery can be prevented with the help of estrogen supplementation to stimulate uterine healing; and by placing a balloon or IUD to prevent the walls from sticking to each other during the post-operative healing phase.

You can read more about Asherman's syndrome here !