Asherman’s syndrome means scar tissue (adhesions) has formed inside the uterus. The scar tissue can make the walls of the uterus stick together, which makes the space inside smaller. It is usually caused by a past uterine procedure or infection, and it can lead to light or missed periods, pelvic pain, difficulty getting pregnant and repeated miscarriages.
The good news is that Asherman’s syndrome can be diagnosed and treated, usually with a short hysteroscopic procedure, and many women go on to have a healthy pregnancy. In this guide, reviewed by Dr. Manish Banker, you will learn the symptoms, causes, how it is diagnosed, how it is treated and what it means for your fertility.
Quick answer
- What it is: scar tissue inside the uterus, also called intrauterine adhesions.
- Main cause: damage to the lining of the uterus, most often from a D&C after a miscarriage or delivery.
- Main symptoms: very light or no periods, pelvic pain, difficulty conceiving and repeated miscarriage. Some women have no symptoms.
- Diagnosis: hysteroscopy (the most accurate test), HSG or a special ultrasound.
- Treatment: hysteroscopic surgery to remove the scar tissue, followed by treatment to help the lining heal.
- Fertility: many women can conceive after treatment. The outcome depends on how severe the adhesions are.
What is Asherman’s Syndrome?
Asherman’s syndrome is a condition in which scar tissue forms inside the uterus after the lining (endometrium) has been damaged. The lining is where an embryo implants and where the monthly period comes from. When scar tissue replaces it, the lining cannot grow properly.
It is also called intrauterine adhesions, uterine synechiae and Asherman-Fritsch syndrome. You may also see it written as Asherman syndrome, Asherman’s syndrome or Ashermans syndrome. They all mean the same thing.
Adhesions can be mild (thin, filmy bands), moderate or severe (thick bands that block a large part of the uterus). The more severe the adhesions, the greater the effect on periods and fertility.
Asherman’s syndrome is acquired, which means you are not born with it, and it is not caused by cancer.
How common is Asherman’s Syndrome?
In the general population it is uncommon, but it is much more common in women who have had uterine procedures. Studies suggest that around 1 in 5 women who have a D&C after a miscarriage develop some adhesions, and the chance goes up with repeated procedures. Many mild cases are never diagnosed because they cause no symptoms.
Who Is at Risk of Asherman's Syndrome?
You are at higher risk if you have had:
- a D&C (dilation and curettage) after a miscarriage, abortion or delivery, especially more than once
- surgery for retained placenta
- hysteroscopic surgery to remove fibroids, polyps or a uterine septum
- a myomectomy or other uterine surgery
- a pelvic infection or endometritis (infection of the uterine lining)
- genital tuberculosis
- radiation to the pelvis or uterine artery embolisation (a procedure that blocks blood flow to fibroids)
Is Asherman’s Syndrome hereditary?
No. Asherman’s syndrome is not passed down in families. It develops after damage to the uterine lining, so it is an acquired condition.
Symptoms of Asherman's Syndrome
While some people with Asherman’s Syndrome may not experience any symptoms a all, some might experience the following:
- Hypomenorrhea:Hypomenorrhea is a condition where an individual assigned female at birth experiences abnormally low bleeding during their menstrual cycles.
- Amenorrhea:Amenorrhea is a condition characterised by an unusually low or no bleeding at all during one’s menstrual cycle.
- Unusually sharp cramping or pelvic pain.
- Difficulty in conception or difficulty in staying pregnant.
- While for a lot of people, Asherman’s Syndrome might go unnoticed, many might experience an unusual pain in their pelvis region and many might experience various menstrual abnormalities.
What Causes Asherman's Syndrome?
Asherman’s syndrome happens when the base layer of the uterine lining is damaged, and the raw surfaces heal by sticking together as scar tissue. The most common causes are below.
D&C (Dilation & Curettage)
This is the most common cause. In a D&C the inside of the uterus is scraped to remove tissue, for example after a miscarriage, an abortion or a retained placenta after delivery. At these times the lining is soft and easily damaged. Most women have cramping afterwards, and repeated D&Cs raise the risk of scar tissue.
Operative Hysteroscopy
A hysteroscopy is a procedure using a thin camera passed through the cervix. Operative hysteroscopy is used to remove fibroids, polyps, a uterine septum or old adhesions. When large raw areas are left close together, they can stick together and form new adhesions.
C-Section (Cesarean Section)
A C-section is a less common cause. Scar tissue is more likely if there was an infection or a later D&C after delivery.
Pelvic infection
Infection of the uterine lining (endometritis) after delivery, miscarriage or procedures can damage the lining and lead to adhesions.
Genital tuberculosis
Tuberculosis of the genital tract can seriously damage the uterine lining and is an important cause of adhesions in India. It may cause few symptoms, so it is tested for in women with unexplained adhesions.
Other causes
Pelvic radiation, uterine artery embolisation and, rarely, an intrauterine device (IUD) with infection can also lead to adhesions.
How Is Asherman's Syndrome Diagnosed?
Your doctor will ask about your periods and any past D&C, uterine surgery, infection or pregnancy loss. A pregnancy test and hormone blood tests are often done first, to rule out other reasons for light or missed periods. The scar tissue itself is confirmed with one of these tests:
Hysteroscopy
A thin camera is passed through the cervix to look inside the uterus. It is the most accurate test, because the doctor can see the adhesions directly. Treatment can often be done at the same time.
Hysterosalpingogram (HSG)
An X-ray test in which dye is passed into the uterus. Adhesions show up as gaps or irregular shapes in the dye. HSG also shows whether the fallopian tubes are open.
Saline sonohysterography or 3D ultrasound
Sterile saline is placed in the uterus while an ultrasound is done, which makes the walls and any adhesions easier to see. A 3D ultrasound gives a detailed view of the uterine cavity.
MRI
Used in some severe cases to look at the uterus and lining in more detail.
Asherman's Syndrome Treatment
Treatment is needed if you have symptoms such as painful periods or very light periods, or if you want to get pregnant. It is not usually needed for mild adhesions that cause no problems and no fertility issues.
Hysteroscopic adhesiolysis (the main treatment)
Under anaesthesia, the surgeon passes a hysteroscope into the uterus and cuts the scar tissue using fine instruments, while looking at the inside of the uterus on a screen. It is usually a day-care procedure. In severe cases the surgeon may use ultrasound or laparoscopy at the same time, to protect the uterus.
Treatment to help the lining heal
Scar tissue can come back, so after surgery your doctor may advise:
- Oestrogen tablets for a few weeks, often followed by progesterone, to help the lining grow back
- A temporary balloon or device placed in the uterus to keep the walls apart while they heal
- Antibiotics in some cases, to prevent infection
- A second hysteroscopy a few weeks later to check that the cavity is open, and to remove any new adhesions
Severe adhesions may need more than one procedure.
What happens after treatment?
Most women find that their periods improve after treatment. Whether you can conceive depends on how severe the adhesions were and how well the lining recovers. Your doctor will review your periods and your lining with ultrasound after the procedure.
Asherman's Syndrome and Pregnancy: Can You Get Pregnant?
Yes, many women with Asherman’s syndrome can get pregnant, usually after the scar tissue has been treated. Untreated adhesions can stop an embryo from implanting and make a miscarriage more likely.
The chance of pregnancy after treatment depends mainly on how severe the adhesions were. It is generally better after treatment of mild or moderate adhesions than severe ones, and it is lower if the lining stays thin.
Can you get pregnant naturally with Asherman's syndrome?
Some women can, especially with mild adhesions. If you have been trying for a year (six months if you are over 35), or your periods are very light or absent, see a fertility specialist.
IVF and Asherman's syndrome
IVF does not remove scar tissue. If the uterus has adhesions or a thin lining, an embryo may not implant even if it is healthy. So the scar tissue is usually treated first, and the lining is checked before embryo transfer. In rare, severe cases where the uterus cannot be repaired, other options such as gestational surrogacy may be discussed.
Risks during pregnancy
A pregnancy after Asherman’s syndrome should be followed closely. Possible risks include miscarriage, premature birth and problems with the placenta, such as it being attached too deeply or covering the cervix. Early scans and regular antenatal care help detect these.
Can Asherman's Syndrome Be Prevented?
Not always, but you can lower the risk:
- Avoid unnecessary D&C. After a miscarriage, ask whether medicines or a gentler suction procedure are an option.
- If a procedure is needed to remove tissue from the uterus, ask for it to be done under hysteroscopic guidance by an experienced doctor.
- Get infections such as endometritis and pelvic infection treated promptly.
- Ask about screening for genital tuberculosis if you have repeated pregnancy loss or unexplained adhesions.
- After any uterine surgery, go to your follow-up visits and report light or missing periods.
When Should You See a Doctor?
See a gynaecologist or fertility specialist if:
- your periods became very light or stopped after a D&C, delivery or uterine surgery
- you have monthly pelvic pain but little or no bleeding
- you have had two or more miscarriages
- you have been trying to conceive for a year (six months if you are over 35)
Banker IVF understands the complexities of Asherman’s Syndrome and provides personalised guidance and treatments to enhance the chances of successful conception for those navigating this condition.
FAQ
What is Asherman syndrome?
Asherman syndrome is a condition in which scar tissue (adhesions) forms inside the uterus, usually after a D&C, uterine surgery or infection. The scar tissue can make periods light or absent and can affect fertility. It is also called intrauterine adhesions.
What are the symptoms of Asherman's syndrome?
The main symptoms are very light or no periods, pelvic pain or cramps around the time of your period, difficulty getting pregnant and repeated miscarriage. Some women have no symptoms.
What causes Asherman's syndrome?
The most common cause is a D&C after a miscarriage or delivery. Other causes include hysteroscopic surgery, uterine infection, genital tuberculosis, and rarely a C-section, pelvic radiation or an IUD with infection.
Can you get pregnant with Asherman's syndrome?
Yes, many women can, especially after the scar tissue has been treated. The chance depends on how severe the adhesions are and how well the uterine lining recovers.
How is Asherman's syndrome diagnosed?
It is diagnosed with a hysteroscopy, which shows the adhesions directly, or with an HSG, a saline sonohysterography or a 3D ultrasound. Your doctor may also do blood tests to rule out other causes of missed periods.
How is Asherman's syndrome treated?
The main treatment is hysteroscopic adhesiolysis, a procedure in which the scar tissue is cut away using a thin camera. Afterwards, oestrogen tablets and sometimes a temporary balloon or device are used to help the lining heal.
Can Asherman's syndrome go away on its own?
No. Scar tissue inside the uterus does not usually disappear without treatment. If you have symptoms or want to conceive, you need to see a doctor.
Is Asherman's syndrome hereditary?
No. It is not passed down in families. It develops after damage to the uterine lining, so it is an acquired condition.
Can Asherman's syndrome come back after treatment?
Yes, adhesions can form again, especially if they were severe. That is why a follow-up hysteroscopy is often done after surgery, and why oestrogen treatment is given to help the lining heal.
Does Asherman's syndrome affect IVF?
It can. IVF does not remove scar tissue, and a scarred or thin lining may stop an embryo from implanting. So the adhesions are usually treated first and the lining is checked before embryo transfer.
