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Asherman Syndrome (intrauterine adhesions)

Home Asherman Syndrome (intrauterine adhesions)

Introduction

Every woman, at some point in her life, goes through an episode of gynecological illness. Worldwide there are millions of women who suffer from different types of such conditions that affect the female reproductive organs, like the breasts, the uterus, ovaries, fallopian tubes, vagina, and vulva. If not given timely attention, gynecological disorders can have devastating results.

One such disorder is the Asherman Syndrome (intrauterine adhesions). Also known as intrauterine synechiae or uterine synechia, it is a rare and acquired gynecological condition.

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What Happens in Asherman Syndrome?

Although it is not a frequently occurring issue, both physicians and women must be aware of this condition so that they can identify it early.

Named after Dr. Asherman, an Israeli gynaecologist, this syndrome is defined by the growth of scar tissue inside the uterus and/or cervix, because of which the walls of these organs are stuck together, causing the uterus to shrink. In severe cases, the whole front and back walls of the uterus can get fused. In the milder cases, smaller areas of the uterus get affected due to the adhesions. The adhesions can be thick or thin, can form sparsely or in a merged format.

What Causes Asherman Syndrome?

One of the primary causes behind the occurrence of this health condition is scar tissue from a uterine surgery like dilation and curettage (D&C). This is considered to be the cause for over 90 per cent of the cases of Asherman Syndrome (intrauterine adhesions). D&C procedure is mostly performed after an incomplete miscarriage, an elective abortion, and for treating retained placenta after delivery.

Other causes include:

  • ● Endometriosis: A disorder where the tissue which lines the inner part of the uterus starts growing outside it
  • ● Radiation treatment
  • ● Formation of scar tissue after a cesarean section
  • ● Pelvic surgeries for the removal of polyps or fibroids
  • ● Due to the usage of sutures to stop hemorrhages
  • ● Infections in the reproductive organs

What are the Symptoms of Asherman Syndrome?

The most common symptom of Asherman Syndrome (intrauterine adhesions) is interrupted or no menstruation (amenorrhea). Also, you may experience extreme abdominal pain during the anticipated time of your period but may not have any bleeding. This is because the exit of the uterus is obstructed due to the adhesions.

Other symptoms can be difficulty or inability to conceive, recurrent miscarriages, stillbirth, and increased cramping. Some women get no symptoms, and their periods are regular too.

At the same time, if your periods are absent, sparse, or irregular, this can also be due to:

  • ● Stress
  • ● Obesity
  • ● Polycystic Ovarian Syndrome (PCOS)
  • ● Intake of a contraceptive pill
  • ● Pregnancy
  • ● Menopause
  • ● Sudden weight loss

What are the ways to Diagnose Asherman’s Syndrome (intrauterine adhesions)?

It is quite tricky to diagnose Asherman Syndrome (intrauterine adhesions) as the symptoms are not exclusive to it and may go undetected in a routine physical examination or an ultrasound scan. If your doctor doubts this problem, he or she will suggest the below-mentioned ways to diagnose it accurately:

  • Hysterosalpingogram (HSG): This technique can help your doctor to evaluate the condition of your fallopian tubes and uterus. During this, a particular dye is injected into the uterus. This makes it easier for your doctor to identify the issue in the uterine cavity, any blockages, or growths in the fallopian tubes, on an X-ray.
  • Saline Infusion Sonography (SIS): It is also referred to as Sonohysterosonography or ultrasound of the uterus. In the SIS method, your doctor uses a saline solution that flows into the uterus to give a clearer image of any irregularities.
  • Hysteroscopy: The best diagnostic method to identify Asherman Syndrome (intrauterine adhesions) is hysteroscopy. In this procedure, your doctor will dilate your cervix and then insert a hysteroscope, a telescope-like instrument with a camera attached to it. This instrument can prove extremely useful in looking inside the womb and also find out the presence of scar tissue.

How is Asherman Syndrome Treated?

With all the advancements in the field of medicine, even a rare condition like Asherman Syndrome is completely treatable today. If you are found to be suffering from this syndrome, then hysteroscopy is the suggested surgical procedure. This procedure aims to reinstate the size and shape of the uterine cavity that will help in restoring normal reproductive function.

Conducted under general anesthesia, in this, your doctor will pass a hysteroscope till your uterus, and then with the help of micro-scissors, or an electrocautery loop, or a laser, he or she will cut the adhesions. Once the procedure is done, there are some devices that doctors recommend using during the preliminary phase of healing. One of the devices is the Foley catheter, which has an inflated balloon that keeps the surfaces of the uterus separate to prevent the formation of any adhesions.

You will also be given antibiotics; to avoid any infection and even for the betterment of the uterine lining. After a few days, your doctor will perform a repeat hysteroscopy to check if the surgery was successful. Only after this you can be assured that you are free from Asherman Syndrome.

What is the Outcome?

Firstly, the treatment ensures regular periods. Secondly, for women planning to conceive, it is highly recommended that post-surgery, wait for a year before you start trying to conceive because the adhesions can pose a threat to the developing fetus.

What Are the Possible Complications?

Very rarely, complications like bleeding, pelvic infection, or perforation of the uterus may occur.

How Can I Prevent Myself From Asherman Syndrome?

The safest way to prevent Asherman Syndrome (intrauterine adhesions) is to avoid the D&C procedure. Still, if the procedure is needed, then it is better to go for an ultrasound scan to determine and lower the damage to the uterus.

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FAQ's

Can Asherman Syndrome (Intrauterine Adhesions) Recur?

The success rate of the surgery to this problem is high; however, in a subset of patients, this problem can recur.

Can I Conceive Post-Treatment?

Yes. It certainly augments your chances to conceive and have a successful pregnancy. However, it is advisable that you are under stringent medical supervision throughout your pregnancy.

Can Asherman Syndrome be Treated Non-Surgically?

It is not possible to cure Non-Surgically.

Can Asherman Syndrome Treatment Help in Curing Infertility?

There can be cases where Infertility might not get cured.

How Many Surgeries will I Need?

The number of surgeries varies from patient to patient and also on the severity of scarring.

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