Uterine Adhesions

Uterine adhesions at a glance

  • Intrauterine adhesions (also referred to as Asherman’s Syndrome) form when scar tissue builds up between the inner walls of the uterus causing the walls to bind together.
  • Intrauterine adhesions are commonly diagnosed with an x-ray procedure called a hysterosalpingogram (HSG).
  • A hysteroscope is generally used to remove intrauterine adhesions, although there is still not much data proving the procedure decreases the chance of miscarriage.
  • Laparoscopy may also be performed in order to see the surface of the uterus to avoid perforating it during hysteroscopy.
  • The original severity of the uterine adhesions determines reproductive potential after treatment.

What are intrauterine adhesions?

Intrauterine adhesions (also referred to as Asherman’s Syndrome) form when scar tissue builds up between the inner walls of the uterus causing the walls to bind together. Intrauterine adhesions often occur after trauma to the uterine cavity, such as dilation and curettage (D&C), which is performed for pregnancy termination or miscarriage, excess uterine bleeding after childbirth, or other gynecological conditions. Other causes may be from outpatient surgeries that remove tissue such as polyps or fibroids or endometritis (an infection of the uterus lining.

Uterine adhesions are a different condition than uterine fibroids or endometrial polyps, and are treated differently. Women with adhesions may not experience any symptoms, and some women may only experience absent, light, or infrequent menstruation cycles. The more significant effects of uterine adhesions can be inability to get pregnant or recurrent miscarriages. In more rare cases, the menstrual flow may be blocked by the adhesions, causing pelvic pain or dysmenorrhea (painful menstrual periods).

Intrauterine adhesions are commonly diagnosed with an x-ray procedure called a hysterosalpingogram (HSG), which uses a small catheter placed through the cervix to pump a dye into the uterus for viewing. Saline ultrasonography, where a saline solution is inserted into the uterine cavity and an ultrasound is performed, can also detect adhesions. A hysteroscopy can also diagnose intrauterine adhesions and remove or cut them out during the same surgery.

Intrauterine adhesions treatment

A hysteroscope is generally used to remove intrauterine adhesions, although there is still not much data proving the procedure decreases the chance of miscarriage. Laparoscopy may also be performed in order to see the surface of the uterus to avoid perforating it during hysteroscopy. High-resolution ultrasonography is especially helpful in combination with hysteroscopy and can also be used to prevent perforating the uterus. In severe cases, it may take more than one procedure to successfully treat uterine adhesions. In addition, the patient may be prescribed hormones or NSAIDS (nonsteroidal anti-inflammatory drugs) to prevent the adhesions from forming again, and sometimes the surgeon may recommend placing a structural plastic catheter inside the uterus for several days or even weeks to keep the walls apart while healing takes place.

After hysteroscopic breakup of uterine adhesions, any pregnancies that follow have an increased likelihood of complications, such as preterm labor, third trimester bleeding, and abnormal placenta attachment to the uterine lining.

Fertility after adhesion removal

According to figures compiled by the American Society of Reproductive Medicine, the type and severity of the adhesions correlates with following reproductive outcomes. Patients who had mild to moderate uterine adhesions removed have 70 percent to 80 percent full-term pregnancy success rates, and menstrual dysfunction is usually alleviated. If the intrauterine adhesions were severe or caused extensive damage to the endometrial lining, full-term pregnancy success rates are only 20 percent to 40 percent after treatment. For women who have extensive endometrium damage that does not respond to hysteroscopy treatment, using a gestational carrier may be the best or only option to achieve pregnancy.