What It Is
Intrauterine adhesions (IUAs), also known as Asherman’s Syndrome, occur when scar tissue forms inside the uterine cavity, causing the walls of the uterus to stick together. This can reduce or completely block the uterine space, affecting menstrual flow and fertility.
Key Features
- Scar tissue bands within the uterus
- Adhesions may be thin and filmy or thick and dense
- Can partially or fully block the uterine cavity
- Often develops after uterine surgery or infection
Causes and Risk Factors
- Uterine surgeries such as dilation and curettage (D&C) after miscarriage, abortion, or postpartum bleeding
- Cesarean section or myomectomy
- Pelvic or uterine infections, particularly endometritis
- Tuberculosis of the uterus (rare, more common in certain regions)
Symptoms
- Light or absent menstrual periods (hypomenorrhea or amenorrhea)
- Painful menstruation (if menstrual blood is trapped)
- Infertility or recurrent miscarriage
- Pelvic pain
- Sometimes no symptoms until fertility problems occur
Impact on Fertility
- Can block sperm from reaching the egg
- May prevent embryo implantation due to a reduced or damaged endometrial lining
- Increases risk of miscarriage if implantation occurs in poorly vascularized tissue
Diagnosis
- Hysterosalpingography (HSG) – X-ray with contrast to view uterine cavity
- Sonohysterography (SIS) – ultrasound with saline infusion to detect adhesions
- Hysteroscopy – gold standard; allows direct visualization and treatment of scar tissue
Treatment Options
- Hysteroscopic adhesiolysis – minimally invasive surgical removal of adhesions
- Estrogen therapy post-surgery to stimulate endometrial regeneration
- Temporary placement of intrauterine devices (IUDs) or balloon catheters after surgery to keep uterine walls apart during healing
- Antibiotics if infection is involved
Prevention
- Gentle surgical techniques during uterine procedures
- Avoiding unnecessary D&C procedures
- Prompt treatment of uterine infections
- Preventive use of barrier devices after high-risk surgery