Causes of Adhesions in Asherman’s Syndrome

Causes of Adhesions in Asherman’s Syndrome most frequently follow a D&C procedure.

Asherman syndrome may be underdiagnosed. Routine examinations or diagnostic procedures such as an ultrasound scan do not always detect adhesions. It can occur in up to 13% of women undergoing a termination of pregnancy during the first trimester. It occurs in 30% in women undergoing a dilation and curettage (D and C) after a late spontaneous abortion.

Women with placental abnormalities (e.g., placenta increta) may have a higher risk of developing Asherman syndrome. The placenta adheres to deeper layers within the uterus and becomes more difficult to remove. The incidence may be as high as 23.4% in patients undergoing procedures two to four weeks after the initial procedure for a vaginal delivery or missed abortion. The risk increases for patients undergoing repeated procedures for bleeding. It is worse in repeated elective termination of pregnancies.

It is found in 1.5% of women evaluated with a hysterosalpingogram (HSG) for infertility. Adhesions exist in between 5 and 39% of women with recurrent miscarriage. Asherman’s Syndrome may occur in 31% of women after the initial hysteroscopic resection of leiomyoma and up to 46% after the second hysteroscopic resection.

Asherman syndrome may go unrecognized in women who are not trying to conceive since they may not recognize or be concerned with the symptoms. These women may have hypomenorrhea.

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