Uterine adhesions, also known as intrauterine adhesions (IUA) or Asherman’s syndrome in severe cases, are benign bands of scar tissue that form inside the uterus. These adhesions cause the inner walls of the uterus to stick together, reducing the space within the uterine cavity. They are generally not cancerous, developing in response to injury or infection.
Understanding Uterine Adhesions
Uterine adhesions form when the endometrium, the tissue lining the uterus, experiences injury or infection, leading to scar tissue. This scarring varies from thin bands to thick tissue that may partially or totally block the uterine cavity.
Common causes include uterine surgeries involving the lining, such as dilation and curettage (D&C) for miscarriage, pregnancy termination, or abnormal bleeding. Other causes are surgical removal of fibroids (myomectomy), C-sections, and infections like endometritis or pelvic inflammatory disease.
Symptoms often include changes in menstrual patterns, such as absent, light, or infrequent periods, and pelvic pain if menstrual flow is obstructed. Adhesions can also contribute to difficulties conceiving or recurrent miscarriages.
Adhesions and Cancer Risk
Uterine adhesions are not cancerous growths. They result from the body’s healing response to trauma or infection, not abnormal cellular proliferation, and therefore do not transform into cancer.
It is important to distinguish adhesions from actual uterine cancers, such as endometrial cancer, uterine sarcoma, or cervical cancer. Endometrial cancer originates from malignant cell growth in the uterine lining, while uterine sarcoma develops in the uterine muscle wall. Cervical cancer begins in the cells of the cervix. Adhesions can sometimes be a complication of cancer treatments, such as radiation therapy for pelvic cancers.
Recognizing Concerning Symptoms
While symptoms of uterine adhesions, like pelvic pain or abnormal bleeding, can occur, certain “red flag” symptoms may indicate a more serious underlying condition, including potential cancer. Persistent or worsening pelvic pain unrelated to the menstrual cycle requires medical evaluation. Abnormal vaginal bleeding is a common symptom of uterine cancer, especially bleeding between periods or any bleeding after menopause.
Other concerning symptoms include unusual vaginal discharge (foul-smelling or blood-tinged), unexplained weight loss, changes in bowel or bladder habits (like difficult urination or constipation), or a palpable abdominal mass. These symptoms, particularly in combination, suggest prompt medical assessment to rule out conditions like endometrial cancer or uterine sarcoma.
Diagnosing and Managing Adhesions
Diagnosing uterine adhesions involves imaging techniques to visualize the uterus. Hysteroscopy is the most accurate method for both diagnosis and treatment. This procedure involves inserting a thin, telescope-like instrument through the cervix to directly view the uterine cavity.
Other diagnostic tools include hysterosalpingography (HSG), an X-ray with dye to outline the uterus, and saline sonohysterography (SHG), an ultrasound with sterile fluid to enhance visualization.
Once diagnosed, surgical removal, often hysteroscopically via hysteroscopic adhesiolysis, is the primary treatment. After surgery, recurrence prevention measures include placing a temporary device like a plastic catheter or balloon inside the uterus to keep walls separated, and prescribing hormonal medications such as estrogen to promote uterine lining healing.