Uterine scar tissue, also known as intrauterine adhesions, refers to the formation of fibrous tissue within the uterus. In more severe instances, this condition is formally recognized as Asherman’s Syndrome. This fibrous tissue can range from delicate, thin bands to more extensive adhesions where the uterine walls may partially or completely fuse together. It forms as a consequence of the body’s natural healing response to injury or inflammation.
How Uterine Scar Tissue Develops
Uterine scar tissue develops following trauma to the endometrial lining. The most frequent cause is uterine surgery, particularly procedures like Dilation and Curettage (D&C), often performed after pregnancy complications such as miscarriage or retained placental tissue. Other surgical interventions, including C-sections and myomectomy (removal of fibroids), can also contribute to scar tissue formation.
Infections also play a role in the development of intrauterine adhesions. Severe pelvic infections, such as pelvic inflammatory disease or endometritis, can damage the endometrium, leading to scar tissue. Radiation therapy to the pelvis for cancer treatment can also result in uterine adhesions.
Identifying Uterine Scar Tissue
Identifying uterine scar tissue involves recognizing a pattern of symptoms. Common indicators include changes in menstrual patterns, such as very light periods (hypomenorrhea), absent periods (amenorrhea), or infrequent bleeding. Some individuals may also experience pelvic pain or severe cramping, particularly if the scar tissue obstructs menstrual flow. Difficulty conceiving a pregnancy or experiencing recurrent miscarriages are also frequent symptoms that prompt investigation.
Diagnosis of uterine scar tissue begins with a review of symptoms and medical history. Hysteroscopy is a key method for confirming the presence and extent of intrauterine adhesions. This procedure involves inserting a thin, lighted telescope with a camera through the vagina and cervix to directly visualize the inside of the uterus. Other diagnostic methods include hysterosalpingography (HSG), which uses X-rays and a dye to reveal the uterine cavity’s shape, and transvaginal ultrasound, sometimes enhanced with saline infusion (sonohysterography), to identify filling defects or blockages.
Effects on Uterine Health and Fertility
Uterine scar tissue can significantly impact a person’s reproductive health. Its effect on fertility is a major concern, as adhesions can interfere with a fertilized egg’s ability to implant in the uterine lining. Even if conception occurs, the risk of recurrent miscarriage is elevated due to the compromised uterine environment and reduced blood supply to the endometrium. Scar tissue can also block the fallopian tube openings, further impeding natural conception.
Beyond fertility challenges, uterine adhesions can lead to complications during pregnancy. These include an increased risk of abnormal placentation, such as placenta accreta, where the placenta attaches too deeply into the uterine wall. This condition can result in significant bleeding during and after delivery. There is also a heightened risk of preterm labor and, in some cases, the need for a C-section delivery. The scar tissue can distort the uterine shape, making it difficult for the uterus to expand properly as a pregnancy progresses.
Approaches to Managing Uterine Scar Tissue
Managing uterine scar tissue involves surgical intervention to restore the uterine cavity. Hysteroscopic adhesiolysis is a common and effective minimally invasive procedure. During this surgery, a hysteroscope is inserted through the cervix into the uterus, allowing the surgeon to directly visualize and carefully remove the fibrous bands using small instruments. This procedure aims to restore the normal shape and function of the uterus.
After surgical removal of adhesions, strategies are used to prevent their recurrence. These post-surgical measures can include the temporary placement of a device, such as an intrauterine device (IUD) or a balloon catheter, inside the uterus for several days to keep the uterine walls separated during healing. Hormone therapy, often involving estrogen, may also be prescribed to promote the regeneration of the uterine lining and aid in healing. The selection of these management strategies depends on the severity of adhesions and individual circumstances.