Asherman’s Syndrome, or intrauterine adhesions/scarring or synechiae, is an acquired uterine condition, characterized by the formation of adhesions (scar tissue) inside the uterus and/or the cervix.
In many cases the front and back walls of the uterus stick to one another. In other cases, adhesions only occur in a small portion of the uterus.
The extent of the adhesions defines whether the case is mild, moderate, or severe. The adhesions can be thin or thick, spotty in location, or confluent. They are usually not vascular, which is an important attribute that helps in treatment.
Stage 1 – Diagnosis
- Normally done by your OBGYN when problems have occurred such as absence of menstruation and abdominal pain. In some cases women continue to have a very light period however have no success in conception.
- Diagnosis is usually made by having an HSG, SHG or diagnostic hysteroscopy.
- In most cases your OBGYN will refer you to a Reproductive Endocrinologist or a doctor who specializes in laparascopic surgery. If at all possible, you should consult an A list doctor who has many years of experience treating AS. If that is not possible, interview doctors using a pre-established list of questions, the most important being: How many Asherman’s patients do you see per year. Obtain a copy of your medical records from all doctors who have treated you.
- Under no circumstances should you allow a doctor to operate on you before you have done your homework!
Stage 2 – Treatment
- You will need to have Hysteroscopic and possibly Laparascopic surgery to remove your adhesions. This is the most important phase of your treatment. Only a highly skilled surgeon with experience in AS should do this. Protecting your uterine lining is very important.
- After your surgery you will most likely have a balloon catheter inserted into your uterus, this is used to keep your uterine walls from adhering together during the healing process. Your Dr. may want this to stay inside for 5-14 days. You will also take an antibiotic to prevent infection. Note, not all Dr.’s use a balloon.
- Once the balloon is removed you will be prescribed a regimen of estrogen and progesterone. The dose and length of this regimen will vary depending on your doctor.
- 2-3 months after your surgery you should have an HSG, SHG or diagnostic hysteroscopy to view the inside of your uterus and your fallopian tubes for remaining scar tissue.
- Subsequent surgery may be necessary.
Stage 3 – Living With Asherman’s
- If you have healed from your surgery and your uterus is free of scar tissue your doctor may give you the “green light” to try and conceive. It is very important that this not be rushed and that your uterus is at least 90% free of scar tissue before getting pregnant. Some of the risks that you now face with carrying a child are: Placenta Previa, Placenta Accreta, Premature rupture of membranes and possibly incompetent cervix. Click here for more information about pregnancy risks.
- During your continued treatment your GYN/RE may want to track your ovulation and measure your endometrial lining and follicles during ovulation. Your Dr. may also suggest that you purchase a fertility monitor to pinpoint your ovulation day and schedule intercourse appropriately.
- Your Dr. may also consider fertility medication. This is usually prescribed when you have a blocked tube or when blood tests indicate a hormonal imbalance. Fertility medication is not necessary for every woman with AS. If your Dr. prescribes this for you, ask why and which type would be the best for you.