About the disease
Intrauterine adhesions, also known as Asherman's syndrome, is a relatively rare condition that develops when scar tissue forms in the uterus or cervix. This scar tissue may cover only a very small surface area or it may cover the entire uterine or cervical area. In some cases, scar tissue develops in several places and becomes confluted. The scar tissue in different areas can vary in structure and thickness.
Each case of intrauterine adhesions is absolutely individual. In some women, it does not cause any problems at all, while in others it can influence the regularity of menstruation or cause considerable pain in the abdomen. The extent to which these symptoms manifest themselves depends on the size of the adhesions and how many of them there are.
The location of the scar tissue can also play an important role. The most common symptom of Asherman’s syndrome is the absence of a menstrual period for a long time. Nevertheless, women may still suffer from abdominal pain around the time their period is supposed to take place. Menstruation may still be happening, but blood is not able to exit the uterus because the scar tissue is creating an obstruction.
The most dangerous complication of intrauterine adhesions is miscarriage, which can occur if the scar tissue affects the development of the fetus. Inability to get pregnant is another serious complication. Most commonly, intrauterine adhesions are caused by previous surgery, or trauma to the uterus, when intrauterine tissue couldn’t fuse together properly and created scarring. According to the International Asherman's Association, between 5% and 39% of women who have suffered recurrent miscarriages have intrauterine adhesions.
Symptoms
- Absence of menstruation
- Cramps during the usual time of menstruation, but no blood
- Inability to conceive a child
- Recurrent miscarriages
Diagnosis
- A hysteroscopy, which is an imaging test of the uterus, helps to determine whether there are any areas of scar tissue in the uterine or cervical area. It can establish how large the intrauterine adhesions are, how many of them there are and whether or not they are creating an obstruction that is stopping the blood from flowing out properly during the normal menstrual cycle. Women who have previously miscarried or had uterine surgery should have regular check-ups, including imaging testing, to avoid further complications.
Treatment
- A hysteroscopy is not only a diagnostic test, but also a surgical procedure that gains access to the intrauterine cavity by means of an endoscope. The surgeon removes scar tissue, thereby repairing the menstrual function. If the patient had been having problems getting pregnant, this procedure should reinstate her childbearing capabilities. This is a minimally invasive surgical procedure and is used to treat many gynecological conditions.
Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko
