Intrauterine adhesions, also known as Asherman’s Syndrome, are scar tissue formations within the uterine cavity. The inner lining, called the endometrium, normally keeps the uterine walls separate. When this lining is injured, the body’s healing response can cause the opposing walls to scar and stick together. This internal scarring can range from thin, filmy bands to thick, dense tissue, reducing the functional space.
Primary Medical Causes
The most common cause of uterine adhesions is trauma to the endometrium’s basal layer, the deep tissue responsible for regenerating the functional lining each month. This injury often occurs during procedures involving instrumentation of the uterine cavity, particularly after a recent pregnancy. The surgical scraping or suctioning involved in a Dilation and Curettage (D&C) procedure is the most frequent trigger.
A D&C is often performed to manage complications following pregnancy, such as a miscarriage, an abortion, or the retention of placental tissue after childbirth. The risk of adhesion formation is higher when the procedure is done in the setting of infection or performed shortly after delivery or a late-term miscarriage. The mechanical trauma damages the regenerative layer, initiating a scarring process that bridges the uterine walls.
Other uterine surgeries can also lead to scar tissue formation. A myomectomy (surgical removal of fibroids) carries a risk, especially if the fibroids are located within the cavity. A complicated Cesarean section or procedures like endometrial ablation, which intentionally destroys the lining to control heavy bleeding, can also cause internal scarring.
Chronic or severe pelvic infections are another contributing factor. Endometritis, an infection of the uterine lining, creates inflammation that damages the endometrium, leading to adhesion formation. Infections like genital tuberculosis are a known cause of significant intrauterine scarring in certain regions.
Recognizing the Symptoms
The presence of uterine adhesions often manifests as changes in menstrual flow because the scar tissue replaces the normal, hormone-responsive endometrium. Many individuals experience hypomenorrhea (significantly lighter or shorter periods). In severe cases, the scar tissue can destroy the functional lining, leading to amenorrhea (the complete absence of a period).
Despite the absence of bleeding, some patients may still experience pelvic pain or severe cramping, known as dysmenorrhea, around the time their period is expected. This pain occurs if the adhesions block the cervix or the lower uterine cavity, trapping the small amount of menstrual blood produced. The accumulating blood creates pressure and causes cyclic pain.
Uterine adhesions also impact reproductive health. The altered environment and reduced surface area of the lining can prevent a fertilized egg from implanting properly, leading to infertility. Scarring and poor blood supply can contribute to recurrent pregnancy loss, as the uterus is less able to sustain a developing fetus.
Treatment and Management
The primary treatment for uterine adhesions is hysteroscopic adhesiolysis. This minimally invasive surgery involves inserting a hysteroscope (a thin, lighted telescope) through the cervix to cut away the scar tissue. The goal is to restore the normal shape and volume of the uterine cavity while minimizing damage to the remaining healthy lining.
After the scar tissue is removed, the focus shifts to preventing the reformation of adhesions, a common complication. A common strategy is placing a physical barrier inside the uterine cavity immediately after surgery. This barrier, such as a balloon catheter or an intrauterine device (IUD), acts as a temporary spacer to keep the uterine walls separated while they heal.
Promoting the regrowth of a healthy endometrial lining is another component of post-operative care. High-dose estrogen therapy, sometimes combined with progesterone, is administered for several weeks. This stimulates the remaining endometrium to proliferate and cover the raw surfaces, aiming to create a thick, functional lining before the temporary barrier is removed.
In cases of moderate to severe adhesions, multiple hysteroscopic procedures may be necessary to fully clear the scarring. Successfully restoring the uterine cavity improves the chances for a return to normal menstrual function and future pregnancy.