Pregnancy: what is Asherman Syndrome?
Asherman syndrome is when scar tissue exists inside the womb or cervix.
Generally this scar tissue doesn’t affect the woman’s health, however it may prevent conception. Additionally, in rare cases Asherman Syndrome could affect the development of the fetus/baby.
How does Asherman Syndrome occur?
Asherman Syndrome occurs more commonly in women who have undergone surgeries that required the uterus to be emptied. These surgeries are performed when there is retained placenta and/or after a miscarriage. However the syndrome is relatively rare and mostly presents when these type of procedures have been carried out more than once.
What are the signs of Asherman Sydrome?
Lots of women will not have any obvious signs of Asherman Syndrome, particularly if the woman has already reached menopause. If the woman is still menstruating, then there may be obvious changes to the menstrual cycle. Periods may become lighter of may stop. Or in some cases periods can become more painful. It is important to note that the incidence of scarring does not relate directly to the symptoms experienced. For example, a woman who has very little scarring may notice that her periods stop. Whereas a woman with more significant scarring may not notice any symptoms whatsoever.
In many cases, women experience a reduced menstrual flow that lasts for a number of cycles. Some women feel as if they are just about to have their period, experiencing the various symptoms of PMT, but then they do not menstruate.
When the scarring happens during a full term birth, then the woman will not observe any change such as lighter periods, until she has weaned her baby and her regular cycle has returned.
How is Asherman Syndrome diagnosed?
Hysteroscopy The only procedure that currently allows for a full assessment and accurate diagnosis of Asherman Syndrome is a hysteroscopy. This is a procedure that involves a small telescope being passed into both the uterus and cervix. This telescope makes it possible for the gynaecologist to be able to view all of the surfaces within the cervix and uterus, to identify if scar tissue is present.
Understanding your medical history Your physician will also ask about your medical history. The majority of women that present with Asherman Syndrome have a medical history of abnormal bleeding, either after giving birth, or having had a miscarriage and have undergone a D & C (curette) or a similar procedure to remove retained material from the uterus.
Sonography Sonography or ultrasound is not a fail safe method of diagnosis, as the scarring is frequently not visible. When scarring presents in the cervix it is even more difficult to diagnose using ultrasound. Therefore it is important to mention that normal ultrasound is not a guaranteed method to entirely rule out the presence of Asherman Syndrome.
RANZCOG © 07|2016 Reproduced with the permission of RANZCOG
Prognosis & treatment options
Although it may be possible to minimise scarring, this is a lifelong condition. Treatment may improve the scarred tissue sufficiently in order to allow the woman to be able to become pregnant.
If the woman does not wish to have more children, and her symptoms are not painful, then there is no reason to seek treatment.
Pregnancy: what is Asherman Syndrome?
The scar tissue is not harmful in itself. As mentioned, you may experience reduced menstruation or no periods.
During a hysteroscopy a gynaecologist can see and remove scar tissue.
Oestrogen can be used to stimulate the growth of the uterine lining. In many cases this will be prescribed after a surgical treatment to reduce the scarring of Asherman Syndrome.
When surgery is required, antibiotics are used to reduce the risks of infection.
The information in this article is not intended to be medical advice. Please do not regard it to be a substitute for direct medical advice. Always seek the professional opinion of your doctor, obstetrician or midwife.