Asherman’s Syndrome Causes, Diagnosis and Treatment Options
Intrauterine scarring, a condition commonly called Asherman’s Syndrome, is being diagnosed with increasing frequency. Although its most common antecedent factors is a curettage performed because of a miscarriage, pregnancy termination or heavy bleeding following a delivery, any uterine surgery can lead to intrauterine adhesions (IUA). Most women with IUA have scanty or absent menstrual periods, but up to one-fourth have painless menses of normal flow and duration. Those who have amenorrhea may also have cyclic pelvic pain caused by outflow obstruction. The uterine lining does develop and breakdown each month but cannot exit the uterus via the cervix and therefore passes into the abdomen via the fallopian tubes. This so- called retrograde menstruation may lead to endometriosis. In addition to abnormal menses, infertility and recurrent spontaneous abortion are common complaints.
Hysteroscopy is the standard method to both diagnose and treat this condition. A thin telescope is placed into the uterus to identify the scars which are then cut with miniature scissors. In order to reduce the risk of scar reformation, we place a specially designed balloon uterine stent inside the uterus immediately after surgery. Post-operative estrogen therapy is prescribed in order to stimulate endometrial regrowth.
Follow-up studies to assure resolution of the scarring are mandatory before the patient attempts to conceive as is careful monitoring of pregnancies for complications such as cervical incompetence, placenta accreta and intrauterine growth restriction. Some of the present-day techniques used to treat IUA were pioneered at California Fertility Partners. Our experience and excellent outcomes have caused to become an international referral center for treatment of patients with intrauterine adhesions.
Written by Dr. Charles M. March