Asherman’s syndrome is a condition characterized by the formation of adhesions (scar tissue) in the uterus. These adhesions cause the walls of the uterus to stick together and narrow the uterine cavity. As a result, menstrual irregularities, infertility and pregnancy complications can occur.
This condition usually develops after intrauterine surgical interventions (abortion, caesarean section, fibroid surgery) or infections. In some rare cases, it may occur without any apparent cause.
The most common causes of Asherman’s Syndrome are:
– Abortion (especially multiple or traumatic abortions)
– Caesarean section (scar formation during the healing process after uterine incision)
– Myoma (fibroid) surgeries
– Intrauterine infections (endometritis)
– Hysteroscopic surgical procedures (polyp removal, septum resection)
– Radiotherapy or rare infections such as tuberculosis
Abortions, especially after pregnancy, pose a higher risk due to the sensitive inner lining of the uterus.
Symptoms vary according to the severity of the adhesions. While some women have no symptoms, others may have the following complaints:
1. Menstrual Irregularities
– Reduced menstrual bleeding (hypomenorrhoea)
– Complete cessation of menstruation (amenorrhoea)
– Painful menstruation (dysmenorrhoea)
– Not menstruating but experiencing abdominal pain (haematometra)
2. Infertility
– Intrauterine adhesions may prevent the embryo from attaching.
– It can cause recurrent IVF failures.
3. Recurrent Miscarriages
– Narrowing of the intrauterine cavity prevents healthy progression of pregnancy.
4. Abdominal Pain and Cramps
– There may be severe pain, especially during menstrual periods.
More than one method can be used for diagnosis:
1. Hysterosalpingography (HSG)
– A contrast medium is injected into the uterus and X-rays are taken.
– It allows adhesions to be seen, but may give false negative results in mild cases.
2. Transvaginal Ultrasound (TVUS)
– Intrauterine structures are assessed, but small adhesions may be missed.
3. Hysteroscopy (Gold Standard)
– The uterus is examined directly with a device with a camera.
– It makes a definitive diagnosis and treatment can be performed in the same session.
4. Magnetic Resonance Imaging (MRI)
– It provides additional information in severe cases, but is not used in routine.
The aim of the treatment is to normalise the uterus by opening the adhesions and to increase the chance of pregnancy.
1. Hysteroscopic Surgery (Adhesyolysis)
– Adhesions are removed by hysteroscopy.
– After the procedure, a temporary balloon/stent can be placed in the uterus.
2. Hormone Therapy (Estrogen)
– Estrogen therapy can be given for 2-3 months to regenerate the lining of the uterus.
3. Infection Prevention
– Postoperative antibiotics are recommended.
4. Preventing Adhesion Again
– An intrauterine device (spiral) may be inserted.
– The patient is called for regular check-ups.
If left untreated, it can lead to infertility. Only after a successful surgical intervention:
– In mild cases, the chance of pregnancy is 70-80
– 50-60% in moderate cases
– 30-40 per cent in severe cases
If pregnancy occurs, the risk of miscarriage, premature birth or placental problems may increase. Therefore, the pregnancy process should be closely monitored.
Yes, it can recur in 20-50% of cases, especially in severe cases. To prevent recurrence:
– Estrogen treatment should be applied after surgery.
– Intrauterine device (spiral) should be used.
– Hygiene rules must be observed to prevent infections.
1. How do I know if I have Asherman’s syndrome?
A hysteroscopy should be performed if your periods have decreased, become painful or you are unable to conceive.
2. Does Asherman’s syndrome go away on its own?
No, it requires treatment. Even mild cases may require surgical intervention.
3. When can I get pregnant after treatment?
Pregnancy can usually be attempted after 3-6 months. Your doctor will set a specific time period for you.
4. Does Asherman Syndrome cause cancer?
No, but if left untreated it increases the risk of infertility and miscarriage.
5. Is treatment without surgery possible?
Hormonal treatment can be tried in mild cases, but hysteroscopy is the most effective method.
6. Can Asherman syndrome be treated with oral contraceptive pills?
No, birth control pills do not open the adhesions. However, estrogen therapy can be given after surgery.
7. Does Asherman Syndrome cause pain?
Yes, it can cause severe cramps, especially during menstrual periods.
8. Can someone with Asherman’s Syndrome have a normal birth?
Yes, but the pregnancy process should be closely monitored
Asherman Syndrome is a condition that can be controlled with early diagnosis and correct treatment. If you are experiencing menstrual irregularities, inability to conceive or recurrent miscarriages, you should consult a gynaecologist and obstetrician.
Asherman Syndrome is a condition that can be treated with the right approach and the chance of pregnancy can be regained. Today, thanks to the development of hysteroscopic surgical techniques, these adhesions can be successfully opened with minimally invasive methods and the uterine health of the patients can be preserved. With early diagnosis and appropriate treatment, the menstrual cycle can be normalised and the fertility potential can be preserved to a great extent.
If you are experiencing menstrual irregularities, inability to conceive or recurrent miscarriages, it is important to be evaluated for Asherman Syndrome. Gynaecology and Obstetrics Specialist Prof. Dr. Şadıman Kıykaç Altınbaş in Ankara can create the most suitable treatment plan for you with her experience in hysteroscopic surgery. Thanks to modern diagnosis and treatment methods, the problems caused by intrauterine adhesions can be effectively solved.
Kızılırmak, Dumlupınar Blv. No: 3 Next Level Ofis A Blok Kat: 14, No: 69, 06510 Çankaya/Ankara
Klinik: +90 538 430 32 10
