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Definition

Asherman syndrome is the formation of scar tissue in the uterine cavity. The problem most often develops after uterine surgery.

Alternative Names

Uterine synechiae; Intrauterine adhesions; Infertility - Asherman

Causes

Asherman syndrome is a rare condition. In most cases, it occurs in women who have had several dilatation and curettage (D&C) procedures.

A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome.

Adhesions in the uterine cavity can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States. Uterine complications related to these infections are even less common.

Symptoms

The adhesions may cause:

  • Amenorrhea (lack of menstrual periods)
  • Repeated miscarriages
  • Infertility

However, such symptoms could be related to several conditions. They are more likely to indicate Asherman syndrome if they occur suddenly after a D&C or other uterine surgery.

Exams and Tests

A pelvic exam does not reveal problems in most cases.

Tests may include:

  • Hysterosalpingography
  • Hysterosonogram
  • Transvaginal ultrasound examination
  • Blood tests to detect tuberculosis or schistosomiasis

Treatment

Treatment involves surgery to cut and remove the adhesions or scar tissue. This can most often be done with hysteroscopy. This uses small instruments and a camera placed into the uterus through the cervix.

After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent adhesions from returning. Your health care provider may place a small balloon inside the uterus for several days. You may also need to take estrogen while the uterine lining heals.

You may need to take antibiotics if there is an infection.

Support Groups

The stress of illness can often be helped by joining a support group. In such groups, members share common experiences and problems.

Outlook (Prognosis)

Asherman syndrome can often be cured with surgery. Sometimes more than one procedure will be necessary.

Women who are infertile because of Asherman syndrome may be able to have a baby after treatment. Successful pregnancy depends on the severity of Asherman syndrome and the difficulty of the treatment. Other factors that affect fertility and pregnancy may also be involved.

Possible Complications

Complications of hysteroscopic surgery are uncommon. When they occur, they may include bleeding, perforation of the uterus, and pelvic infection.

In some cases, treatment of Asherman syndrome will not cure infertility.

When to Contact a Medical Professional

Call your provider if:

  • Your menstrual periods do not return after a gynecologic or obstetrical surgery.
  • You cannot get pregnant after 6 to 12 months of trying (See a specialist for an infertility evaluation).

Prevention

Most cases of Asherman syndrome cannot be predicted or prevented.

References

Brown D, Levine D. The uterus. In: Rumack CM, Levine D, eds. Diagnostic Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 15.

Dolan MS, Hill C, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 18.

Keyhan S, Muasher L, Muasher SJ. Spontaneous abortion and recurrent pregnancy loss: etiology, diagnosis, treatment. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 16.

Williams Z, Scott JR. Recurrent pregnancy loss. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 44.

Version Info

  • Last reviewed on 6/8/2020
  • LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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