16561 Ashermans Syndrome

Overview

Asherman's syndrome is a condition where scar tissue forms inside the uterus (womb). This scar tissue can make the walls of the uterus stick together, reducing the space inside. It can affect your monthly periods and make it harder to become pregnant.

Asherman's syndrome is considered rare. Most gynaecologists see only a small number of cases in their careers, but it may be more common in women who have had multiple uterine procedures.

It affects females of reproductive age, especially those who have had surgery on the uterus, an infection after a miscarriage or abortion, or a cesarean delivery. It is not caused by anything you did or didn't do.

Symptoms

Common symptoms

• Very light or no monthly period
• Pelvic pain or cramping that may get worse during your period
• Trouble getting pregnant or repeated miscarriages
• No bleeding when you expect your period, even though you still have the same cycle

Causes

Main causes

• A previous surgical procedure on the uterus, most commonly a dilation and curettage (D&C) after a miscarriage, abortion, or childbirth
• Cesarean section delivery
• Removal of uterine fibroids (myomectomy)
• Infection in the uterus after a procedure or pregnancy

Risk factors

• Having more than one uterine operation
• A history of pelvic infection or endometritis (infection of the uterine lining)
• Trauma to the uterine lining during medical procedures
• Having a cesarean section, especially with a low transverse incision

When to see a doctor

See a doctor urgently if:

• If you have severe pelvic pain that is getting worse
• If you have heavy bleeding that is unusual for you
• If you have signs of infection such as fever or a bad-smelling discharge

Book a routine appointment if:

• If your periods suddenly become very light or disappear
• If you have difficulty becoming pregnant after trying for several months
• If you have repeated pregnancy losses and are concerned about your uterine health

Diagnosis

A doctor will first ask about your medical history, especially any uterine surgeries or pregnancies. They may then order imaging tests to look at the shape of your uterus and check for scar tissue. The most reliable test is a hysteroscopy, where a thin camera is passed through the cervix to see inside the uterus directly.

Tests that may be done

• Pelvic ultrasound, sometimes with a salt-water infusion called sonohysterography
• Hysterosalpingography (HSG), an X-ray of the uterus and fallopian tubes
• Hysteroscopy, a procedure using a small telescope to look inside the uterus
• Sometimes an MRI scan for more detail

What to expect at your appointment

Diagnosis is usually done as an outpatient visit. You may have some mild cramping or spotting after the tests. Your doctor will explain the findings and discuss treatment options if Asherman's syndrome is found. You may be referred to a gynaecologist who specialises in uterine conditions.

Treatment

Treatment for Asherman's syndrome aims to remove the scar tissue and restore the normal shape of the uterine cavity. This can help return your periods and improve your chances of a healthy pregnancy. Not every case needs surgery; the plan depends on your symptoms and whether you want to have children.

Self-care at home

• For mild pain, ask your pharmacist about suitable pain relief options available over the counter.
• Use a heating pad or warm water bottle on your lower belly for cramps.
• Take time to rest after a procedure, but avoid heavy lifting until your doctor says it's safe.

Medical treatments

Doctors may use hormone medication to help the uterine lining grow and heal after surgery. This is often a short course of oestrogen and sometimes a progestogen, but the exact plan will be tailored to you. Antibiotics may be given if there is an infection. Always take any prescribed medicine exactly as directed.

When is surgery considered?

Surgery is the main treatment for Asherman's syndrome when scar tissue is blocking the uterus or causing symptoms. A gynaecologist performs a hysteroscopy and carefully cuts away the scar tissue. This is usually a day procedure under anaesthesia. Sometimes a balloon or other device is placed inside the uterus for a few days to keep the walls apart while it heals.

Living with this condition

Many women with Asherman's syndrome lead normal daily lives, especially if symptoms are mild. If you have no periods every month, you may have concerns about your body. Tracking your symptoms and keeping regular appointments with your doctor can help you feel more in control.

Lifestyle tips

• Maintain a balanced routine with enough rest and sleep.
• Avoid smoking and limit alcohol, as these can affect blood flow and healing.
• If you are trying to conceive, talk to your doctor about the best time to try after treatment.

Diet and exercise

Eating a variety of foods rich in vitamins and minerals supports overall uterine health. Regular physical activity, like walking or swimming, can improve circulation and reduce stress. Avoid very intense exercise during heavy bleeding or recovery from surgery.

Mental health and emotional wellbeing

Dealing with fertility problems or changes in your periods can be emotionally challenging. It is completely normal to feel sad, anxious, or frustrated. Remember that your worth is not defined by your fertility. If you notice persistent low mood, anxiety, or hopelessness, speak to a mental health professional. If you are ever in crisis, contact your local emergency services or a crisis helpline.

Prevention

Not all cases can be prevented, but you can reduce the risk by having a conversation with your doctor before any uterine procedure. Ask about the risks and whether alternatives exist. After a procedure, follow your doctor's advice about avoiding infection and take any prescribed infection treatment fully.

Complications

If left untreated

• Infertility or difficulty carrying a pregnancy to term
• Repeated pregnancy loss
• Chronic pelvic pain or pressure
• Menstrual problems that may worsen over time

Long-term outlook

The outlook for Asherman's syndrome is often very positive. Many women undergo successful surgery to remove scar tissue and go on to have normal periods and healthy pregnancies. Even if a full cure is not possible, treatment can greatly improve symptoms and quality of life. Your doctor will help you understand your personal situation and support you at every step.

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