Do I Have Asherman's Syndrome?

Dear Doctor,

I have a friend who is having trouble having children because of Asherman's syndrome. I would like to start a family with several children soon, and I am worried about having this syndrome, especially since I had an abortion at 16 weeks. What is Asherman's syndrome, when does it develop, what are the symptoms, the consequences for fertility, and the treatment options?

Valérie*, 27 years old  *name anonymized

Dear Valérie,

Thank you for your important question. Asherman's syndrome is a gynecological condition that can indeed have a significant impact on fertility. Here is a comprehensive overview to address your concerns:

What is Asherman's Syndrome?

Asherman's syndrome is characterized by the formation of scar tissue or adhesions inside the uterus. These adhesions can vary in number and severity, ranging from a few thin bands to almost complete obstruction of the uterine cavity.

When and How Does It Develop?

Asherman's syndrome typically develops after a surgical procedure on the uterus. The most common causes include:

• D&C (Dilation and Curettage) after a miscarriage or abortion, especially when the procedure is performed later in the pregnancy or in the presence of an infection.

• Uterine surgery to remove fibroids or polyps.

• Cesarean sections or other complex uterine surgeries.

Symptoms of Asherman's Syndrome

Symptoms can vary depending on the severity of the adhesions but often include:

• Amenorrhea (absence of menstruation) or very light menstrual cycles.

• Chronic pelvic pain.

• Infertility or difficulty maintaining a pregnancy.

• Recurrent miscarriages.

Consequences for Fertility

Asherman's syndrome can seriously affect fertility by preventing embryo implantation or increasing the risk of miscarriage. The adhesions can hinder the endometrium from regenerating normally, which is essential for successful implantation.

Treatment Options

Fortunately, there are treatments for Asherman's syndrome:

• Hysteroscopic surgery: This is the treatment of choice, where a surgeon uses a thin camera to visualize and remove adhesions inside the uterus.

• Hormonal therapy: After surgery, hormones like estrogen may be prescribed to help the endometrium regenerate.

• Intrauterine devices (IUDs): Sometimes used to keep the uterine walls separated after surgery and prevent reformation of adhesions.

Prevention and Advice

To reduce the risk of Asherman's syndrome, it is essential to:

• Choose experienced practitioners for any uterine procedure.

• Quickly monitor and treat any uterine infections after a procedure.

• Consult regularly with a gynecologist for follow-up exams if you have a history of D&C or other uterine surgeries.

Valérie, while your past abortion may concern you, it is important to note that Asherman's syndrome remains relatively rare. An evaluation by a gynecologist can reassure you and, if necessary, direct you toward appropriate treatments. Your desire to start a family is understandable, and with the right medical care, your chances of achieving this dream remain high.

Kind regards,

Dr. Sandra Yene Amougui