Asherman’s syndrome occurs when scar tissue forms inside the uterus, causing the uterine walls to stick together. These intrauterine adhesions can affect periods, fertility, and pregnancy.
It often develops after a uterine procedure, pregnancy-related treatment, or infection. Symptoms may include very light or absent periods, pelvic pain, difficulty conceiving, or recurrent miscarriage.
Treatment usually involves hysteroscopic removal of the scar tissue to restore the uterine cavity and support better reproductive health.
Asherman’s syndrome develops when the inner lining of the uterus, known as the endometrium, becomes damaged and heals with scar tissue. When the opposing surfaces of the uterus heal together, adhesions can form.
The most common cause is uterine instrumentation, particularly after pregnancy. The risk may be higher when the procedure is performed after a miscarriage, childbirth, or retained pregnancy tissue.
Less commonly, infections or other conditions that cause inflammation inside the uterus may contribute to scarring.
Uterine adhesions may develop after:
Not everyone who undergoes a uterine procedure develops Asherman’s syndrome.
The likelihood depends on factors such as the extent of uterine injury and the circumstances surrounding the procedure.
Certain situations can increase the risk of developing intrauterine adhesions.
These include having a uterine procedure after pregnancy, undergoing repeated D&C procedures, or experiencing an infection or significant inflammation inside the uterus.
A history of uterine surgery may also increase the risk.
Having several procedures does not automatically mean that Asherman’s syndrome will develop, but it is important to discuss unusual menstrual changes or fertility problems with a gynaecologist.
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Symptoms can range from mild to significant, and some people may have few obvious symptoms.
Common signs include:
A change in menstrual flow after a uterine procedure can be an important clue.
For example, someone who previously had regular periods may notice that their periods become unusually light or disappear altogether.
Diagnosing Asherman’s syndrome usually involves a combination of medical history, symptoms, imaging, and direct examination of the uterine cavity.
Your doctor may ask about previous pregnancies, miscarriages, childbirth, D&C procedures, uterine surgery, menstrual changes, and fertility history.
This information can help identify whether intrauterine adhesions are a possibility.
Several tests may be used to examine the uterus, including:
The evaluation begins with a review of your medical and reproductive history. Your specialist may then recommend imaging or hysteroscopy based on your symptoms and previous procedures.
If adhesions are suspected, hysteroscopy can provide a detailed view of the uterine cavity and may also allow treatment during the same procedure.
Intrauterine adhesions can affect fertility because scar tissue may reduce the healthy space available inside the uterus.
Extensive adhesions can also interfere with the normal function of the endometrium and may make implantation more difficult.
Asherman’s syndrome has also been associated with pregnancy complications, including miscarriage and abnormal placental attachment.
However, the impact depends on the location and severity of the adhesions.
Treatment can improve the uterine environment and may increase the possibility of a successful pregnancy, although individual outcomes vary.
The main treatment for Asherman’s syndrome is removing the scar tissue from inside the uterus.
The exact approach depends on how extensive the adhesions are and whether fertility is a priority.
Hysteroscopic adhesiolysis is commonly used to treat intrauterine adhesions.
During the procedure, a specialist guides a small camera through the cervix into the uterus. Surgical instruments can then be used to carefully separate and remove scar tissue.
The goal is to restore the normal shape and space of the uterine cavity while limiting additional injury to the endometrium.
In more extensive cases, treatment may require careful surgical planning and follow-up procedures.
Your specialist may also use imaging or hysteroscopy after treatment to check whether the uterine cavity has healed properly.
One of the challenges of Asherman’s syndrome is that adhesions can sometimes return after treatment.
Depending on the individual case, a specialist may use measures designed to keep the uterine walls separated while healing occurs.
These can include a temporary intrauterine device or balloon, along with medication such as oestrogen to support endometrial healing.
Follow-up assessment is important because recurrent adhesions may need additional treatment.
Recovery depends on the extent of the adhesions and the type of procedure performed. Mild cramping or light vaginal bleeding can occur after hysteroscopic treatment.
Your specialist may recommend avoiding certain activities temporarily and may arrange follow-up imaging or hysteroscopy to assess the uterine cavity.
If you are trying to conceive, your fertility clinic can also advise when it is appropriate to begin attempting pregnancy.
Yes. Intrauterine adhesions can recur, particularly when the original scarring was extensive.
This is why treatment does not always end with the initial hysteroscopy. Follow-up care may be recommended to confirm that the uterine cavity remains open and that significant scar tissue has not returned.
Early assessment of recurring symptoms can help identify problems before they affect fertility or pregnancy planning.
Many people can become pregnant after successful treatment, but pregnancy should usually be monitored carefully.
The risk of complications may depend on how severe the original adhesions were and how well the uterine cavity recovered. Some patients may need closer monitoring during pregnancy because previous uterine scarring can be associated with placental problems or other complications.
If you are planning pregnancy after treatment, discuss your plans with your gynaecologist or fertility specialist so that appropriate follow-up can be arranged.
Consider speaking with a gynaecologist or fertility specialist if you experience significant changes in your periods after a uterine procedure, unexplained absence of periods, difficulty becoming pregnant, or repeated pregnancy loss.
You should also seek specialist advice if you have previously had a D&C or another uterine procedure and later develop symptoms that are unusual for you.
Early diagnosis can be valuable because the condition is treatable, and addressing adhesions may help protect against future infertility.
Asherman’s syndrome occurs when scar tissue forms inside the uterus, which can affect periods, fertility, and pregnancy. It is often linked to previous uterine procedures or inflammation.
Diagnosis may include ultrasound, HSG, or hysteroscopy, while hysteroscopic adhesiolysis is commonly used to remove the scar tissue and restore the uterine cavity.
Because adhesions can return, follow-up care is important. If you notice changes in your periods or have difficulty conceiving after a uterine procedure, speak with a gynaecologist or fertility specialist for proper evaluation and treatment.
