Asherman’s Syndrome

Everything you need to know about this disease and what you can do if you have it.

Asherman’s Syndrome, known simply as AS or intrauterine adhesions (IUA), wasn’t medically acknowledged until 1854 and didn’t enjoy a full description of the disease for another 54 years.

So while it may have taken the medical community a fair bit of time in order to truly understand the havoc that this disease could wreak, it’s taken them decades more to create viable and useful treatments for the problem.

Women all over the world have suffered from multiple severities of AS. Ranging from little to few symptoms, to the disease being a genuine contributing factor to infertility. If you, or someone you love struggles with the disease, it’s important to know that this is something that can be addressed and there is indeed hope for you and the future of your family.

What is Asherman’s Syndrome?

Asherman’s Syndrome is characterized by scar tissue that builds up on the walls of the uterus or cervix. While severity does indeed vary from patient to patient, in the most extreme cases, this scar tissue can cause the walls of the uterus to stick to one another, completely obstructing the cavity.

The uterus lining is comprised of two distinct layers: the functional layer, which is shed during menstruation, and the basal layer, which are the base cells that build the new functional layer after each period. Trauma to the basal layer can lead to scarring and adhesions, which are fibrous bands that can form between opposing walls of the uterus. These adhesions can bind the opposing walls together, obscuring the open cavity of the uterus.

 

Classification of Asherman’s Syndrome

The disease is classified by the American Fertility Society in three stages

  • Mild Disease
    • Thin and delicate adhesions, involving less than ⅓ of the uterine cavity. These patients will experience normal periods or bleed less than usual.
  • Moderate Disease
    • Adhesions that are more dense and durable, that involve ⅓ to ⅔ of the uterine cavity. These patients will experience very little menstrual bleeding.
  • Severe Disease
    • Very dense adhesions that involve ⅔ or more of the uterine cavity. These patients usually do not experience periods.

Asherman’s Syndrome Diagnosis

Diagnosing AS can be done in several ways:

  • Hysterosalpingography (HSG)
  • Ultrasonography
    • Contrast sonohysterography (SHG)
    • 3D ultrasonography
    • Hysteroscopy
    • Magnetic resonance imaging (MRI)

Hysteroscopy is the standard method of evaluation, which is when a physician will insert a thin tube with a light and camera on it into the vagina. This allows your doctor to view your cervix and the inside of your uterus. HSG uses a special dye along with X-ray technology that allows your doctor to look at both your cervical cavity and Fallopian tubes.

Depending on what your physician can find out from one diagnostic test may require them to carry out others. Talk to your physician to find out what tests may be involved in your own diagnosis.

 

What Causes Asherman’s Syndrome?

AS affects women of all races and ages. These issues generally happen following pelvic surgeries, or any other type of intrauterine trauma that may occur. Any number of pelvic interventions can put women at risk of developing Asherman’s syndrome.

  • Dilation and curettage (D&C)
  • Removal of fibroids, cysts, or endometrium
  • Cesarean Sections
  • IUD’s
  • Pelvic irradiation (such as cancer treatments)
  • Schistosomiasis (a type of parasitic infection)
  • Genital Tuberculosis

While this isn’t an exhaustive list of the type of pelvic issues and treatments that can result in AS, these are perhaps the most common factors that affect women globally.

 

What are the Symptoms of Asherman’s Syndrome?

AS is generally suspected when menstrual abnormalities are found. Oftentimes, the severity of these abnormalities correlates with the severity of the syndrome. Infertility is also a symptom of AS and women who experience it will often be tested to see if their uterine cavity is functioning normally. Pain during menstruation and ovulation can also be a sign that the uterus is partially occluded.

Women who have had to undergo a D&C for either elective or medically necessary abortions are highly susceptible to AS following the procedure. This often happens when the body is incapable of removing all of the products of the former conception, and surgeons must go in and manually remove the leftover lining.

Despite this complication, D&Cs are extremely necessary for anyone who has experienced an incomplete abortion. If these products are left within the body, serious complications can easily arise. The dilation and curettage procedure is also used for women who experience issues with polycystic ovary syndrome, uterine fibroids or are experiencing issues with post-menopausal bleeding.

 

What Treatments Are Available?

Luckily, over time physicians and scientists have come to create a number of different treatments and solutions for almost any severity of the disease. One of the most novel and promising treatments for this syndrome, as well as a few others, is endometrial regeneration.

Endometrial Regeneration

Asherman’s syndrome, chronic endometriosis, polyps, endometrial hypoplasia, and poor endometrial thickness are all common causes of infertility. But that’s not the only thing these problems have in common. They also all have the ability to respond positively to endometrial regeneration. Creating a new option for anyone who suffers from them.

Using your very own stem cells, scientists can create and grow healthy uterine lining (endometrium) within a sterile lab setting. Once these cells have grown and proliferated, they are then introduced back into your uterus. Similar to the procedures used during the IVF process. Helping to encourage new and healthy growth. The procedure itself is short, painless, and outpatient. Making it a new and very exciting choice for women who have traditionally been given a few options.

Other Solutions

Should the disease be too severe for endometrial regeneration, or should adhesions first be removed before rebuilding the endometrium, doctors may rely on these methods.

Adhesion Division

Either using the hysteroscope (the thin, lighted tube used in a hysteroscopy) to gently tease the thin adhesions apart, or scissors to cut more dense tissue, your doctor may need to separate the scar tissue bands that are holding the walls of your uterus against one another (adhesions).

Ancillary Treatment

Even once these adhesions have been severed, they can often grow back together. Because of this, doctors may employ ancillary treatments, or certain procedures designed to stop this from happening.

Mechanical Barriers

Mechanical barriers, like specialty tubes, balloons, and gels may be inserted into the uterus to keep those walls apart and stop the tissues from growing back and attaching to one another.

Pharmacological Barriers

Hormone therapy, using estrogen and progestin, can help to stimulate the growth of the functional layer of the uterus, keeping the walls from fusing back together.

Surrogacy

Surrogacy is an option for anyone who has been unable to conceive following an Asherman’s diagnosis, or for anyone who has undergone failed attempts at treatments for the syndrome. Meaning that no matter the severity of the disease, there is always hope for your family.

 

Read our most recent blogpost about From UK to Ukraine: Perspective on Ukraine Surrogacy from Parents Who Have Been There.

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