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Understanding Asherman's Syndrome
Asherman's is a condition that occurs when scars develop in the interior part of your uterus and especially on the uterus walls. This scar tissue, which is also known as intrauterine adhesions, may result in your uterus walls sticking together. In most of those cases, the condition causes period issues, pelvic discomfort, and even infertility.These adhesions tend to arise after an injury in the lining of your uterus, particularly when you are still recovering after a pregnancy, surgery or infection.
The Main Causes of Asherman's Syndrome
1. Dilation and Curettage (D&C)
The D&C operation is the most prevalent reason for Asherman's Syndrome. This is surgery when your doctor scrapes the inside of your uterus. It is usually followed by:- A miscarriage
- A stillbirth
- An abortion
2. Uterine Surgery
When you were operated upon due to fibroids, polyps or any other outgrowths in the uterus, this too can increase your risk of developing scar tissue. Such surgeries can include cutting or scraping open the uterine lining, and this exposes the uterus to adhesions.Other types of surgeries that could lead to this condition include:
- Caesarean section (C-section)
- Endometrial ablation (used to stop heavy bleeding)
- Removal of the uterine septum (a wall inside the uterus)
Any surgical trauma to the uterine lining can potentially lead to Asherman's Syndrome.
3. Postpartum Infections or Complications
In some cases, your uterus can be infected following childbirth, miscarriage or abortion. When not managed promptly, these infections may destroy the inner lining.Some women may also develop Asherman's after excessive bleeding (postpartum haemorrhage) or improper attachment of the placenta to the uterine wall (placenta accreta), which may require medical care.
4. Tuberculosis of the Uterus (Genital TB)
In various regions of the globe, genital TB is a major cause of Asherman Syndrome. When the TB bacteria infiltrate the uterus, they may lead to cumulative inflammation, damage and scarring of the lining tissue of the uterus.Though this is a very low risk in Tier 1 countries, it is a perceived danger in other parts of the globe where TB is more prevalent. If you have had TB or live in an area known to have it, your physician will consider this to be a potential cause.
5. Radiation Therapy
Radiation therapy used to treat cancers in the pelvic area can harm the cells that line your uterus. While this isn't a common cause, it is still possible, especially if high doses are involved or if treatment lasted for a long time.What Happens Inside Your Body?
Once your uterus is damaged or infected, your body initiates the healing process. However, in some cases, the scar tissue grows back in place of the smooth, healthy tissue. This lining does not stretch, shed, or enable usual ovulation and pregnancy like healthy uterine tissue does.Depending on the size and severity of adhesions, you may not even experience any symptoms with small and mild adhesions. However, when the scar tissue is larger, it may stop the flow of menstrual blood, and it may interfere with the implantation and/or spontaneous abortion.
Warning Signs to Watch Out For
You may not always notice obvious symptoms, especially if your periods are already light or irregular. However, you should be alert if you experience:- Very light or absent periods
- Pelvic pain or discomfort
- Difficulty getting pregnant
- Repeated miscarriages
In some cases, your periods may stop completely (a condition called amenorrhea). This is usually one of the most evident signs that something's not right inside your uterus.
How Is Asherman's Syndrome Diagnosed?
If you suspect something is off, your doctor may suggest:- Ultrasound (mainly 3D)
- Hysteroscopy (a small camera inserted into the uterus)
- A hysterosalpingogram (HSG) is an X-ray with dye to check the shape of your uterus
Among these, hysteroscopy is the most reliable way to see the scar tissue and confirm the diagnosis. The good news? In many cases, treatment can begin during the same procedure.
What Can You Do to Prevent It?
While you can't always prevent Asherman's Syndrome, you can reduce your risk by:- Avoid unnecessary D&C procedures
- Choosing medical management for miscarriage or abortion when appropriate
- Getting prompt treatment for infections
- Following up with your doctor after any uterine surgery
If you've had a D&C or surgery and your periods change afterwards, don't ignore it. Early diagnosis leads to better outcomes.
FAQs on What Causes Scarring In The Uterus?
- Is it possible for Ashermanian Syndrome to cure itself?
No, once the scar tissue has appeared, it usually cannot dissolve without treatment. There is usually a hysteroscopic surgery procedure that has to be performed to sever the adhesions and restore the uterus to a normal state. - Is it possible to get pregnant with Asherman's syndrome?
This depends on the severity of the condition. Most women will conceive after treatment, but some with more severe scarring may need extra help or fertility treatment. - How soon after treatment can periods return?
Some women notice improvement in their menstrual flow within a few weeks to a couple of months after surgery. Your doctor will usually monitor your recovery with follow-up scans.
