Asherman syndrome: causes, symptoms and treatment

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The Asherman Syndrome is a morphological alteration of the uterine cavity that is characterized by the presence of scars in it. These lesions cause the formation of adhesions in the uterine tissue between the walls of the uterus, causing it to deform and may even be reduced in size. Therefore, for its diagnosis, it is necessary to perform an ultrasound to evaluate the state of the matrix.

The extension of the adhesions in the uterine cavity determines the degree of affection of this pathology, which can be mild, moderate or severe. In some cases, the walls of the uterus are completely attached and this causes serious problems of infertility. In others, adhesions only occur in a small portion.

Below you have an index with all the points that we will discuss in this article.

Index

Asherman syndrome: causes, symptoms and treatment

Causes of uterine adhesions

Asherman syndrome occurs when the normal process of healing in the uterus is triggered. The most common cause of this healing process is wounds produced as a result of uterine scraping or curettage after miscarriage or voluntary abortion. In fact, the practice of a curettage after the loss of a pregnancy is the most frequent cause of Asherman's syndrome.

Bleeding from a cesarean section or a natural birth can also cause scarring. The operation of myomectomy or other gynecological ailments can also be the cause of this syndrome.

These traumas cause, as in any situation, a subsequent healing process in which scar tissue is generated. This fabric has a high adhesive capacity given its high content of fibrous filaments. This causes the walls of the uterus to stick together or deformities occur in this organ that compromise its main function: gestate.

Uterine adhesions in Asherman's Syndrome

The Asherman syndrome is, therefore, an acquired condition, because it is not born with it, but arises as a result of a previous clinical case.

Diagnosis

To know if a woman suffers from this gynecological pathology, the doctor must check the existence of adhesions and / or alterations in the uterine cavity through a series of tests that are detailed below.

It is very important to take into account the patient's clinical history. It has to be checked if this has suffered previous gynecological or gynecological operations since, in the case of scraping after a spontaneous abortion, there is an 8% chance of contracting Asherman's syndrome. This risk can increase up to 30% if 3 scrapes have been made.

The medical tests necessary for the diagnosis of Asherman syndrome are:

Ultrasound

Ultrasound or ultrasound is a diagnostic test that produces images of the inside of the body. In this case, proceed through the transvaginal route introducing the ultrasound through the vagina to the uterus to observe this cavity.

Check the condition of the uterus by transvaginal ultrasound

This test is usually performed in the first instance, because it is simple, non-invasive and can be easily carried out in consultation. However, sometimes their results are not illuminating given the difficulty in interpreting the images obtained. This requires having to resort to more specialized techniques.

Hysterosalpingography

This medical test consists of a radiography combined with the use of a contrast liquid. This fluid is essential in this test, because when it is introduced into the uterus it expands throughout the cavity until reaching the fallopian tubes and being expelled to the peritoneal space. In this way, the contrast fluid "draws" the shape of the uterus and the tubes. This image is taken through an x-ray, which is done after inoculating the contrast.

Hysterosalpingography to diagnose Asherman

Hysterosalpingography is a more complete test than ultrasound, because the presence of adhesions, obstructions or alterations such as myomas or polyps is easier to detect.

However, although it does not require anesthesia or is very painful, it is a complicated procedure that must be scheduled and performed in a specialized room.

Hysteroscopy

Finally, if the diagnosis after the previous tests continues being doubtful, a diagnostic hysteroscopy can be performed. This test consists of introducing a camera to the uterine cavity to be able to observe it.

Visualize the uterine cavity by hysteroscopy

The determination of the pathology is much more reliable with this test, since the visualization of the adhesions is more direct.

symptom

The most common symptoms in Asherman syndrome are:

  • Alterations in menstruation: usually, there are prolonged periods of absence of menstrual bleeding (amenorrhea), mainly because the adhesions obstruct the exit of blood clots from the uterus to the vagina.
  • Pelvic or abdominal pain: as a result of the retention of menstrual bleeding, women may feel pain during periods of rule or intermenstrual periods.
  • Retrograde menstruation: the impediment of the exit of the endometrial tissue can cause this tissue to be released retrograde to the abdominal cavity through the tubes. Blood released in this way can be established by forming cysts or endometriomas.
  • Repeated miscarriage: the deformation of the uterine cavity as a result of the adhesion of its walls prevents the proper development of a pregnancy. If this condition is not treated, recurrent abortions may occur.

These symptoms are very general and could be related to many other gynecological pathologies besides Asherman's syndrome. Therefore, it is necessary to carry out exhaustive tests to determine the cause of these signs.

It is much more likely that they are an indication of the presence of Asherman's syndrome if they occur suddenly after a curettage, scraping or other uterine surgery.

Treatment

If the results of the aforementioned tests show that this syndrome is suffered, it is necessary to intervene surgically, since this condition can be quite painful and have very negative consequences for the fertility of the woman.

The treatment of Asherman syndrome consists in the removal and cauterization of the adhesions so that the uterus recovers its normal size and shape. Generally, this procedure is performed by a surgical hysteroscopy during which, in addition to the optical system through which the uterus is visualized, specialized microsurgical instruments are used to section the adhesions.

Once the scar tissue has been removed, it is important that the uterine cavity remains expanded to prevent the reappearance of adhesions. For this, there are several methods:

  • Uterine balloon: is a small probe that is inserted into the uterus and, once inside and positioned, it expands keeping the uterine walls separated, while they heal.
  • Estrogen treatment: estrogen-based drug treatment may also be necessary during the days after surgical hysteroscopy. This hormone stimulates the natural growth of the initially damaged endometrial tissue, preventing the tissue that causes the adhesions from growing.
  • Continuous Hysteroscopy: some doctors recommend more comprehensive reviews to women who have suffered this syndrome since they have greater predisposition to return to suffer.

Incurable asherman

There is a variety of Asherman Syndrome that is more difficult to treat. This variety is called "incurable Asherman" or endometrial sclerosis.

In this condition, which may coexist with the presence of adhesions, the uterine walls are not stuck together, but the endometrium has completely disappeared.

Although curettage can cause this situation, it is much more likely to occur after a uterine operation such as a myomectomy. In these cases, given that the basal root of the endometrium has been removed, the amenorrhea that derives from this situation is not due to menstrual bleeding being retained, but there is no tissue to expel during the period.

Can Asherman's syndrome be completely cured?

Depends on the degree to which it is present, because the more severe it is, the more tendency the patient will have for the reappearance of adhesions.

Can uterine adhesions occur after a cesarean section?

Yes, a cesarean section can be a reason for adhesions to occur, since being a surgical intervention will produce a healing process as a result of the incisions made to remove the baby.

Is pregnancy viable if you suffer from Asherman syndrome?

The presence of uterine adhesions during pregnancy seriously compromises that it can develop normally. Therefore, it is necessary to remove these tissues before the woman becomes pregnant.

Is Asherman syndrome a cause of endometriosis?

It is possible that the blood clots retained by the adhesions can be released retrograde to the abdominal cavity, standing on the tubes or ovaries and forming cysts. Presenting Asherman syndrome may be a reason to develop endometriosis, because the mechanism of retrograde menstruation is precisely the cause of it.

Recommended reading

According to most clinical sources, performing a curettage is the most common cause of this syndrome. Curettage is a surgical procedure often necessary after the loss of a pregnancy. We tell you what is in the link you have below: The uterine curettage.

The formation of adhesions causes the uterus to narrow and reduce its internal cavity. This, obviously, prevents a pregnancy can be carried to term, because the fetus can not develop normally due to lack of space. Therefore, an abortion ends up occurring. If you want to know what signs are symptoms of abortion and what other causes can cause it, click on the following link: Abortion: causes and symptoms.

At the end of this post we have commented that the incurable Asherman syndrome arises from the total destruction of the endometrium. This tissue is very important in the reproductive cycle of women. We recommend that you read the following article to know more about it: What is the endometrium?

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