Asherman’s Syndrome

What is Asherman’s Syndrome?

Asherman’s Syndrome is a gynaecological condition in which scar tissue (also called intrauterine adhesions) forms inside the uterus and sometimes the cervix. These adhesions can partially or completely block the uterine cavity, interfering with normal menstrual function and fertility.

The condition can range from mild, with thin adhesions affecting a small area of the uterus, to severe, where dense scar tissue significantly distorts or obliterates the uterine cavity.

What Causes Asherman’s Syndrome?

Asherman’s Syndrome most commonly develops after damage to the endometrial lining, usually following uterine procedures. The most frequent cause is dilation and curettage (D&C), particularly when performed after:

  • Miscarriage
  • Childbirth
  • Termination of pregnancy

Other recognised causes include:

  • Uterine or pelvic surgery (e.g. caesarean section, removal of retained placenta, fibroid surgery, polypectomy)
  • Uterine infections such as genital tuberculosis or schistosomiasis (rare in developed countries)
  • Repeated or aggressive uterine procedures, especially when the endometrium is thin or inflamed

Symptoms of Asherman’s Syndrome

Symptoms vary depending on the extent and location of the adhesions. Some women may experience minimal symptoms, while others develop significant reproductive problems.

Common symptons include:

  • Light, irregular, or absent periods (secondary amenorrhoea)
  • Pelvic or cyclical pain when a period would normally occur
  • Difficulty conceiving
  • Recurrent miscarriage or repeated implantation failure

Women who notice changes in their menstrual cycle or fertility following a D&C or uterine surgery should seek specialist assessment.

How is Asherman’s Syndrome Diagnosed?

The gold standard for diagnosing Asherman’s Syndrome is hysteroscopy, a minimally invasive procedure that allows direct visualisation of the uterine cavity and any adhesions present.

Additional investigations may include:

  • 3D transvaginal pelvic ultrasound
  • Saline infusion sonography
  • Hysterosalpingogram (HSG)
  • MRI (in selected or complex cases)

Treatment for Asherman’s Syndrome

The most effective treatment is hysteroscopic adhesiolysis, a specialised minimally invasive surgical procedure performed by an experienced reproductive surgeon. During the procedure, adhesions are carefully divided using a hysteroscope to restore the normal shape and function of the uterine cavity.

Care After Surgery

To reduce the risk of adhesions reforming, post-operative management may include:

  • Temporary placement of a copper uterine device
  • Hyaluronan-based gel to reduce intrauterine adhesions reforming
  • Oestrogen therapy to promote healing and regeneration of the endometrium
  • Intrauterine platelet rich plasma (PRP)

Fertility and Pregnancy After Treatment

Outcomes following treatment are often very positive, particularly when managed by a specialist in reproductive surgery.

  • Menstrual cycles improve in most patients
  • Pregnancy rates after hysteroscopic adhesiolysis range from 42–62%
  • Adhesions recur in approximately one-third of cases, particularly in severe disease
  • Some women may require repeat surgery in complex cases

Early diagnosis and expert care significantly improve fertility and pregnancy outcomes.

When Should You See a Specialist?

You should seek specialist assessment if you experience:

  • Absent or very light periods after uterine surgery
  • Ongoing difficulty conceiving
  • Recurrent miscarriage

Consultation with a clinician specialising in fertility medicine and reproductive surgery is essential for accurate diagnosis and optimal treatment.

Get in touch with Ed for Asherman’s Syndrome Treatment >