Asherman’s syndrome is an acquired condition of the uterus. Women with this condition sustain scar tissue or adhesions that form in the uterus due to some form of trauma. In severe cases, the entire front and back walls of the uterus can fuse together. In milder cases, the adhesions can appear in smaller areas of the uterus. Most cases occurs with several dilatation and curettage (D&C) procedures. A severe pelvic infection unrelated to surgery may also lead to Asherman’s syndrome.
Asherman’s syndrome is not life-threatening, however, some women with this condition cannot conceive or will experience recurrent miscarriages. The risk of miscarriage and stillbirth are both higher in women with Asherman’s syndrome. Women with this condition are also more at risk of suffering from bleeding during pregnancy. However, if it is treated fertility can be restored.
Symptoms might include:
The most reliable method of diagnosing Asherman’s syndrome is hysteroscopy. This involves inserted a hysteroscope through the cervix to see the uterus. You may also have a hysterosalpingogram (HSG) which uses contrast dye to show blockages on an X-ray
Most cases of Asherman’s syndrome result after a dilation and curettage (D and C) procedure which is usually carried out after an incomplete miscarriage, as a means of pregnancy termination or if the placenta is retained after delivery. The risk of developing this condition increases with the number of D and C procedures had. Other causes of Asherman’s syndrome include severe pelvic infections and other forms of pelvic surgery (e.g. caesarean section and fibroid or polyp removal).
Discussing the risks and complications of the D & C procedure is always necessary unless the situation does not allow (if the patient is unconscious). As a minimum the risks outlined should include: bleeding, infection, injury to uterus (and what type of injury), secondary laparoscopy/laparotomy, hysterectomy as a last resort, formation of intrauterine adhesions (Asherman’s Syndrome). Failure to provide details of the risks and how they can affect the patient would fall below the expected standard of care.
Further risks occur if a second surgical procedure is undertaken. It is well recognised that ultrasound scans to investigate post-partum haemorrhage have varying levels of sensitivity and specificity. The RCOG Guidelines suggest that the diagnosis of retained products by ultrasound is unreliable. Surgery is only one possible option. treating bleeding conservatively using drugs including ergometrine, oxytocin-analogues, or tranexamic acid should be offered and discussed.
It is clear that a repeat curettage and particularly with a sharp curette poses an increased risk to the uterine lining e.g. of developing intrauterine adhesions (Asherman’s Syndrome) or atrophy. Thus the decision to perform a second procedure should be weighed up against the expected risks and alternatives discussed.
Any subsequent surgery should also be undertaken, if undertaken at all, by an experienced physician such as a Consultant obstetrician / gynaecologist. One would also expect a suction curette or dull curette or a removal under hysteroscopic vision but not the use of a sharp curette so as to prevent further damage.
Asherman syndrome can often be cured with surgery. This is by cutting and removing the adhesions or scar tissue. This can be done with a hysteroscopy to avoid invasive, open surgery. It requires general anaesthesia and after surgery, oestrogen may be given to improve the quality of the uterine lining. Adhesions can recur following surgery, so it may be necessary to wait for up to 12 months before trying to conceive. Sometimes more than one procedure will be necessary. Women who are infertile because of Asherman’s syndrome may be able to have a baby after treatment.
Asherman’s Syndrome is rarely spoken about and many women are undiagnosed and untreated. It is often a painful and heart-breaking condition affecting fertility. For many who are undiagnosed or diagnosed too late they cannot access the treatment needed for the painful, irreversible situation of being childless. Some have rounds of IVF treatment which is unsuccessful as the Asherman’s syndrome has not be treated and this adds to the heart-break .
We deal with a number of Asherman’s cases and understand the difficulties in accessing appropriate treatment and care. If you have Asherman’s and feel that is may be as a result of surgical trauma then get in touch with Dr Victoria Handley today. Don’t suffer in silence. Call FREE on 0800 470 2009 or email firstname.lastname@example.org