TREATMENT OF ASHERMAN’S SYNDROME
Asherman syndrome should be treated by a surgeon experienced with hysteroscopy in order to prevent further damage. They should use sonographic or laparoscopic guidance. It is recommended that removal of the scars is done with scissors to prevent further scarring. Cold cut scissors are least likely to create new scarring. Women are often given oral, transdermal, or intramuscular estrogen preparations to help to reduce scarring postoperatively. They help to promote regeneration of the normal endometrium.[1]
Devices to prevent the apposition of the uterine walls may also reduce scar formation. The devices (like a balloon) are placed intraoperatively but need to be monitored carefully. It is important to reduce the unintended risk of atrophy of the wall due to pressure from the device.
Experimental protocols to rebuild the endometrium by infusing stem cells derived from the patient may provide some promise in the future. These stem cells may be derived from the patient’s blood cells, fresh or freeze-dried amniotic tissue, or other sources. However, further studies are needed to confirm the safety, efficacy, and risks associated with these protocols.
Adhesive gels containing synthetic hyaluronidase to reduce the recurrences of the adhesions has not confirmed any benefit.
Reevaluation one to two weeks postoperatively may allow earlier identification of recurrent adhesions while small and allow resection before these adhesions worsen.
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