Uterine adhesions, also known as intrauterine adhesions or Asherman’s syndrome, are bands of scar tissue that form inside the uterus. These bands develop on the uterine walls, causing internal surfaces to stick together. This scarring can decrease the open space within the uterus.
What Uterine Adhesions Are
The uterus is naturally a hollow organ, somewhat like a balloon, with its front and back walls typically resting against each other. The inner lining of the uterus, called the endometrium, is where an embryo implants during pregnancy and where the superficial layer sheds during menstruation. When the endometrium experiences injury or infection, the body initiates a healing response.
This healing process involves scar tissue formation. Scar tissue is tougher and less flexible than normal tissue. While essential for repairing damaged areas, this process can sometimes lead to the abnormal binding of uterine walls, creating adhesions. These adhesions can range from thin, stretchy bands to thick, dense scar tissue, potentially causing partial or complete blockage of the uterine cavity.
Surgical Interventions
Surgical procedures involving the uterus are a frequent cause of uterine adhesion formation. Any operation that damages the delicate endometrial lining can trigger the body’s scar tissue response. The risk of developing adhesions often increases with the extent of uterine tissue trauma during surgery.
Dilation and Curettage (D&C) is a common procedure where the cervix is opened and tissue from the uterine cavity is removed. This procedure, often performed following miscarriage, childbirth complications like retained placental tissue, or for abnormal bleeding, can injure the endometrium and lead to adhesions. The likelihood of scar tissue forming is higher if there is an infection or inflammation during or after the D&C.
Myomectomy, the surgical removal of uterine fibroids, particularly those located within the uterine cavity, can also result in adhesions. Similarly, a Cesarean section, a surgical procedure for childbirth, involves an incision into the uterus that can lead to scar tissue formation. Stitching during a C-section, especially with infection, can contribute to adhesion development. Hysteroscopy, a procedure where instruments are inserted into the uterus, also carries a risk of adhesion formation due to potential endometrial trauma.
Infections and Inflammatory Conditions
Infections and inflammatory conditions within the reproductive tract can contribute to the development of uterine adhesions. The body’s immune response to these conditions can lead to inflammation, which in turn promotes scar tissue formation.
Pelvic Inflammatory Disease (PID), an infection of the female reproductive organs, is a common cause of inflammation that can result in adhesions. Endometritis, an inflammation of the uterine lining, also contributes to scarring within the uterus. Sexually transmitted infections (STIs) can sometimes lead to PID or endometritis, initiating the inflammatory cascade that ultimately forms adhesions.
When the uterine lining experiences prolonged or severe inflammation due to these conditions, the normal healing process can be disrupted. This disruption leads to excessive scar tissue production, binding parts of the uterus that should remain separate. The resulting scar tissue can obstruct the uterine cavity and impair its normal function.
Other Contributing Factors
Beyond surgical procedures and infections, other less common factors can contribute to the formation of uterine adhesions. For instance, radiation therapy to the pelvic area, used in certain cancer treatments, can cause damage to uterine tissues and subsequently lead to scar tissue formation. In rare instances, individual differences in healing responses or genetic predispositions might influence susceptibility to adhesions.