Have you noticed that your monthly period has suddenly decreased significantly or stopped completely after you had a D&C, or a hysterectomy? Are you experiencing more severe abdominal pain than usual during your period? Are you still dreaming about having a baby? Often we think of these things as normal, maybe hormonal changes, and forget about them. But this may be a condition that really needs medical attention. We are talking about one such condition today. That is Asherman's Syndrome .
Simply put, what is Asherman's Syndrome?
Simply put, Asherman syndrome is the development of scar tissue or adhesions inside your uterus and/or cervix. Doctors sometimes call this ``intrauterine adhesions''.
Think of your uterus as a small balloon. Normally, the inside walls of this balloon are free-flowing, without sticking together. But what happens if for some reason these inner walls become injured, and as those injuries heal, scars form, and the walls start to stick together? That's what happens here too. These adhesions reduce the amount of space inside the uterus. This can cause problems like pain, irregular periods, and infertility.
You feel good about your body. If you notice a change in your menstrual cycle or new pain, it's best to talk to a doctor instead of assuming, "This is normal."
How do you know if you have Asherman syndrome? What are the symptoms?
Not everyone experiences the same symptoms. Some people may not experience any symptoms at all. But there are a few common symptoms. Let's take a look at what they are.
| Symptom | A simple explanation |
|---|---|
| Hypomenorrhea (very little menstrual blood flow) | Why would someone who used to have a period that lasted 4-5 days now only have spotting for a day or two? |
| Complete cessation of menstruation (Amenorrhea) | Suddenly missing a period for months without any reason. |
| Severe lower abdominal pain (Dysmenorrhea) | Unbearable pain during the days leading up to menstruation or when menstruation is due. |
| Difficulty conceiving a child (Infertility) | Inability to get pregnant despite trying for a long time without any form of birth control. |
| Recurrent Miscarriages | Even if you get pregnant, the embryo fails to implant and develop properly in the uterus, resulting in a miscarriage. |
Sometimes, even though you don't have a period, you may still feel cramping when your period is due. This means that your period is actually happening, but the scar tissue may be blocking the passageway inside your uterus and preventing the blood from coming out.
Why do these types of adhesions occur? What are the main reasons?
The main reason for these adhesions to form is some damage or injury to the inner lining of the uterus, the ``Endometrium.`` Especially if two parts of the inner wall of the uterus that face each other are injured at the same time, the likelihood of them sticking together as they heal is high.
Doctors divide the reasons for this into two main categories.
1. Pregnancy-related causes
Research has found that more than 90% of Asherman syndrome cases are caused by a D&C (Dilation and Curettage) procedure performed during pregnancy. A D&C is simply a procedure that removes and cleans the inside of the uterus. These are the situations in which a D&C may be performed:
- To terminate a pregnancy.
- Remove the remaining parts of the uterus after an incomplete miscarriage.
- If any parts of the placenta remain in the uterus after the baby is delivered, remove them.
The uterus is very sensitive after pregnancy. At such times, even a small amount of damage to the ``endometrium`` can lead to the formation of large scar tissue. Very rarely, this condition can also occur after a cesarean section (C-section).
2. Causes not related to pregnancy
Although a D&C is often performed for pregnancy-related reasons, D&Cs and other surgeries are also performed for other reasons.
- If you suspect uterine cancer, get a tissue sample (biopsy).
- Remove polyps in the uterus.
- Hysteroscopy is a surgical procedure to remove uterine fibroids.
- Surgery to remove a septate uterus.
In addition to this,
- Severe pelvic infections
- Things like radiation therapy to the pelvic area can also cause this.
How is this condition diagnosed? What tests are done?
When you tell your doctor about your symptoms, he or she will ask about your medical history, especially any previous surgeries (like a D&C). Then, they will recommend several tests to confirm the condition.
The best and most accurate test for this is a diagnostic hysteroscopy. This involves inserting a very thin tube with a camera attached through your vagina and cervix and examining the inside of your uterus. This allows the doctor to clearly see how many adhesions are inside the uterus and what their nature is.
In addition, a ``Transvaginal Ultrasound Scan'' can also be done. Sometimes, during this scan, a small amount of saline solution is injected into the uterus, causing the uterus to swell slightly before the scan. This allows a better picture of the inside of the uterus and any adhesions, if any, to be obtained.
Are there stages of severity for Asherman syndrome?
Yes, this condition can be divided into several stages depending on the severity. This will help you and your doctor get a better understanding of the situation.
| Stage | Description |
|---|---|
| Mild Disease | There are a few thin, membrane-like adhesions in less than a third of the uterus. Menstruation may be normal or slightly reduced. |
| Moderate Disease | Between one-third and two-thirds of the uterus has a mixture of thin and thick adhesions. Menstruation is significantly reduced. |
| Severe Disease | More than two-thirds of the uterus is covered with thick adhesions. Often, menstruation has stopped completely. |
What are the treatments for this?
There are treatments for this. The main goal of treatment is to remove scar tissue and restore the uterus to its normal shape. If you are not in pain and do not wish to have children, you may not need any treatment. However, if you have symptoms, treatment may include:
- The pain can be relieved.
- The menstrual cycle can be restored.
- The ability to conceive a child can be restored.
The main treatment is Operative Hysteroscopy. This is similar to a diagnostic hysteroscopy. However, in this procedure, a camera and a very fine pair of scissors or a laser are inserted into the uterus and the adhesions are carefully cut away. This procedure may need to be done more than once, depending on the severity of the condition.
Things to take care of after surgery
The biggest challenge after this surgery is the risk of adhesions coming back. Your doctor will take several steps to prevent this.
- Giving hormonal medications: Giving the hormone estrogen helps the lining of the uterus (endometrium) grow quickly and well.
- Insertion of a barrier into the uterus: A small balloon (intrauterine balloon) or catheter may be placed inside the uterus for a few days after surgery to prevent the uterine walls from sticking together.
- Giving antibiotics: These are given to prevent infection while something like a balloon is in place.
You may be re-examined about a week or two after surgery to see if new adhesions have started to form.
Is it possible to have a child with Asherman syndrome?
This is a big question for many people. It's hard to give a straight "yes, you can" or "no, you can't." It depends on the severity of your condition and the success of your treatment.
In general, people with moderate to severe Asherman syndrome have a slightly lower chance of becoming pregnant and maintaining a healthy pregnancy even after treatment.
According to one research:
- Of those with mild adhesions, 60.7% became pregnant after treatment.
- Of those with moderate adhesions , 53.4% became pregnant after treatment.
- 25% of those with severe adhesions have become pregnant after treatment.
Don't be alarmed by these statistics. Your doctor will give you the best understanding of your situation. The most important thing is to be open and honest with your doctor about your fertility goals.
If a woman with Asherman syndrome becomes pregnant, it is considered a high-risk pregnancy. Your doctor will monitor you and your baby very closely because there is a small chance of complications such as preterm labor and placenta previa.
Take-Home Message
- Asherman syndrome is the formation of scar tissue (adhesions) inside the uterus.
- This condition often occurs after a surgery such as a D&C (dilation and curettage).
- The main symptoms are decreased or absent menstruation, severe pain, and difficulty conceiving.
- This condition can be accurately diagnosed through a hysteroscopy.
- These adhesions can be treated with surgery to remove them. However, there is a risk of the adhesions recurring.
- This condition can affect your fertility, so it's important to talk openly with your doctor about your future plans.
- You are not alone. This condition can be managed with the right medical treatment and guidance.
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