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An acquired condition, Asherman’s syndrome, also known as uterine synechiae or intrauterine synechiae (adhesions), refers to a presence of scar tissues in the cervix or the uterus.

This scar tissue causes the cervix and uterus to stick together, thereby reducing the uterine size.

Uterine scars are also known as intrauterine adhesions.

Causes

Intrauterine adhesions are fibrous scar tissue bands that form within the uterus. These scar tissue affects uterine lining and is one of the primary causes of infertility.

A uterus has three layers:
  • Serosa or the outer layer
  • Myometrium or middle muscular layer
  • Endometrium or inner layer. The endometrium contains the lining which sheds during the menses. The inner layer is also where the embryo gets implanted and grows into a viable pregnancy.
Scars in the uterus are formed due to trauma to the functional lining either due to an inflammation and/or procedure. Chances of scars are maximum when a woman undergoes a uterine procedure while having an infection.

Some of the potential causes include:

Surgical


  • Cesarean section
  • D&C (dilation and curettage) for abnormal uterine bleeding, miscarriage, prior abortion, or retained placenta
  • Myomectomy

Infection/Inflammation


  • Endometritis – uterine cavity infection
  • Other infections (chlamydia, schistosomiasis, tuberculosis) of reproductive organs

Other


  • Radiation treatment

Symptoms

Scars in the uterus are very rare. Scientists do not have any clear idea of how often it happens as a proper diagnosis is rare.

Some studies state that it is prevalent in 20% of patients who underwent dilation and curettage after pregnancy complications.

Some of the common symptoms include:
  • Amenorrhea (no periods)
  • Hypomenorrhea (very light periods)
  • Having severe pain or cramping
  • Unable to either get pregnant or stay pregnant
Some women have normal periods, while some have no symptoms even when suffering from uterine scarring.

Workup


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Physical Examination

Your doctor will get your medical history and do a physical examination.

While physical adhesions will not help in finding adhesions, it will indicate a blockage in the cervix if the instrument is unable to enter the cervix.

Hormone Test

The doctor could also order hormone tests, which will help in ruling out endocrine problems, or might use hormones to induce bleeding.

Saline Infusion Sonography (SIS)

Another option with your doctor is saline infusion sonography. Also known as sonohysterography or uterine ultrasound, SIS involves using a saline solution that flows into the uterus, helping in getting a clear image of the uterus.

Hysterosalpingography(HSG)

Also known as uterosalpingography, HSG combines radioactive material and X-ray. The radioactive material is placed in the fallopian tubes and the uterus to indicate any blockages or growths.

Hysteroscopy

Hysteroscopy is the best bet when it comes to diagnosing scars in the uterus. Hysteroscopy involves your doctor placing a telescope and camera in the uterus to view the entire uterine cavity.

Treatment

The treatment goal is to help the uterus get back to its regular shape and size.

Besides diagnosing the scars, hysteroscopy is also used to treat them. The adhesions are cut with the help of lasers, small scissors, or any other instrument which uses electrodes or hooks.

After hysteroscopy, the doctor usually places a balloon catheter inside the uterus for a specified period. Estrogen therapy is also prescribed for decreasing scar reformation.

Sometimes, you might be required to undergo more than one hysteroscopic procedures to treat the scars successfully. Additionally, the doctor might prescribe hormones that will help in getting your uterine line back on track and allowing you to have regular periods.

Recurrence rates are generally around 34% in cases of mild-to-moderate adhesions and more than 65% in cases of severe adhesions.

Hysteroscopy should be performed by a highly experienced surgeon or a fertility specialist. Successful treatment is known to result in pregnancy, with live birth rates in the range of 30 to 70%.