Intrauterine Adhesions (Asherman's Syndrome)

Asherman's syndrome is scar tissue inside the uterus that causes its walls to adhere to each other. These bands of scar, or intrauterine adhesions, damage the endometrium, the lining of the uterus.

The scars form after an injury to the uterus. The most common causes are dilation and curettage (D&C), other uterine surgery, or severe infection inside the uterus. A D&C is a procedure that scrapes the uterine lining.

Some adhesions are thin and filmy and cover only a small area. Others are dense and fill most or all of the uterine cavity.¹²

Periods that stop (amenorrhea) or become much lighter after a uterine procedure are among the most common symptoms. Monthly pelvic pain without bleeding is another common symptom. Infertility and repeated miscarriage are common as well. Some women have no symptoms, even when the scarring is significant.

Hysteroscopy is the best test to find and grade the adhesions. A saline ultrasound (saline infusion sonohysterography) can suggest scarring. An HSG, an x-ray of the uterus and tubes with contrast dye, can also suggest it.

Neither of these tests can grade the adhesions accurately. Diagnostic hysteroscopy places a thin camera inside the uterus. The surgeon then sees how much scar is present, where it lies, and how thick it is.

Operative hysteroscopy is the restorative treatment. The surgeon cuts and removes the adhesions under direct vision (adhesiolysis). This procedure restores the normal shape of the uterine cavity.

Care after surgery includes hormone support to help the endometrium regrow. A follow-up office hysteroscopy checks the result. Both steps are standard parts of the restorative approach.

Asherman's syndrome is a structural cause of infertility and miscarriage, and it can be corrected. An evaluation for recurrent pregnancy loss should include an assessment of the uterine cavity. This step matters most for women who have had past uterine procedures.

Related structural conditions can occur at the same time. These include a uterine septum and an isthmocele. The same evaluation should assess for them as well.