There`re lots of women out there who struggle to become pregnant, only to eventually find they are suffering of Asherman`s syndrome, a rare condition that many of them have never even heard of.
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What Is Asherman`s Syndrome?
Asherman`s syndrome represents a rare medical condition that is characterized by the presence of fibrosis and/or adhesions in the uterus because of scars. The syndrome appears more commonly after a surgical abortion performed to a pregnant woman. This condition may appear in all circumstances, as the same procedure is used in all these cases.
Asherman`s syndrome affects women of any race or age with a genetic basis or predisposition. Depending on the degree of severity, this syndrome might lead to:
- Future obstetric complications.
- Pain through the blood blocked in the uterine cavity.
- Repeated abortions.
If left without treatment, the obstruction of the menstrual blood through adhesions may lead to endometriosis.
This medical condition appears in up to 30% of retained products and 25% of cases of surgical abortion performed at 1 to 4 weeks postnatal. If the pregnancy is lost, the time between fetal removal and curettage might increase the likelihood of forming adhesions because of fibroblastic activity of the tissue that remained. The syndrome`s risk increases depending on the procedures that are performed as well.
What Are the Stages of this Syndrome?
- Minor scars in the uterus or the cervical canal.
- Unless this will involve a particular region of the uterus known as the isthmus, there`ll be a small impact on typical uterine function and treatment isn`t important.
- Still, if the car will involve the isthmus, there may be an important impact on the endometrial function and you should look for treatment.
- Many women can remain pregnant again.
- We most often notice patients coming at this stage of the syndrome.
- There`ll be an inner os obstruction, a very small portion of the cervix which open into the uterine cavity and is blocked rather easily.
- In certain women, this particular obstruction will involve just a fraction of a millimeter, while in other women it may stretch over a few centimeters.
- If the scarring will involve the low end of the uterus, there`ll be no pain and no menstrual blood production.
- Although it`s not so common, in certain situations, women may present mild cramps without bleeding.
- Women with stage 2 of this condition have over 60% chance of remaining pregnant again.
- The uterus will typically contract and over 50% is blocked due to scar tissue.
- There might be an obstruction due to one of the tubal orifices as well.
- The greater scar formation extent, the harder it`s to treat.
- Normally, women have up to 30% chance of remaining pregnant and giving birth again successfully.
- Over 75% of the uterine cavity is blocked and has a smaller size.
- At this stage, treatment needs several visits and has a low rate of success.
- With the stem cell technology introduction, results might improve in the near future.
In some situations, additionally to the associated adhesions, there`s an adhesion of the uterine wall as well. It`s most commonly triggered by an aggression due to curettage. D & C is generally performed to treat specific uterine issues or due to a pregnancy loss.
Every case of this syndrome is distinct, and most causes vary from one case to another. But most frequently, the condition appears due to uterine surgery. Severe pelvic infection, without necessarily being associated with any medical intervention, has been related with the beginning of this illness.
What Are the Symptoms of Asherman`s Syndrome?
If you experience this syndrome, you might have absent or diminished menstruation. Frequently, abdominal cramps or pains may appear during the period when menstruation should occur, but with really experiencing a period. However, there`re cases where women with this syndrome experience a normal period!
Experts claim that from time to time infertility or repeated miscarriages can be considered signs of this syndrome.
What Related Disorders Does this Syndrome Have?
Signs of the following conditions may be rather similar to those of our syndrome. In order to make a differential diagnosis, comparisons might prove to be useful:
- Primary Amenorrhea: it represents the absence or decrease of menstruation for at least 3 months. It might represent the result of lots of gynecological issues. Most of the time, the disorder is the result of too much or too little GnRH.
- Secondary Amenorrhea: it represents the absence of menstruation in women who`ve already menstruated before. However, menstruation stops following acute endometritis or a dilation & curettage.
- Endometriosis: It represents a medical condition that affects lots of women and it`s caused by the inability to shed the tissue buildup which typically forms in the uterine cavity before menstruation.
- Pelvic Inflammatory Disease: Also known as PID, this represents an infection of the uterus, ovaries, fallopian tubes or cervix. It`s more frequently encountered in young women, and can be transmitted by birth, abortion or sexual contact.
- Stein-Leventhal syndrome: It represents a rare disorder that affects mostly young women. The condition is generally characterized by obesity, abnormal or absent menstruation, mild symptoms of secondary male sex features, and sterility.
Can Asherman`s Syndrome Be Cured?
Hysteroscopy is the most important standard for the diagnosis as well as treatment of this syndrome. Ultrasonography doesn`t offer essential diagnostic info, although sometimes ultrasound imaging may push the doctor towards the suspicion of diagnosis.
Hysterosalpingography and sonohisterosalpingography are both used in order to evaluate the lesion extent.
Magnetic resonance imaging and computerized tomography help to the evaluation of secondary complications occurred from the uterine joint (pelvic adhesions and endometriosis).
The biochemical analyzes and hormonal profile show values that are normal.
The fertile prediction will very much depend on the length, severity and extent of the adhesions.
Recent synechiae have favorable prediction with proper treatment. The thick and old synechiae which obliterate the whole uterine cavity generally has a reserved prediction. – Learn more!
Even after the adherents are detached and treatment is followed, the intrauterine environment might still remain unfavorable for embryonic implantation because of the scleroatrophic endometrium.
For the situations where the adhesion of adherents to the uterine cavity is successful, but with the impossibility of tuberculous opening, the probability of procedures of IVF for installing a pregnancy remains.
Still, patients with a pregnancy obtained after treatment for this syndrome have a high incidence of complications associated with pregnancy.
Specialty studies have shown a higher risk of abortion, PROM, placental expulsion, and high incidence of Caesarean malposition. Also, it`s reported an high incidence of cases of abnormal placenta.
The treatment needs to be guided depending on the severity and extent of synechiae.
In the case of recent synechiae, the dilation and debridement of the adhesions can be tried. The maneuver is perfectly made under hysteroscopic guidance.
Once reaching the uterus, the hysteroscope could be used to debride adhesions. If thicker adhesions may be encountered, scissors could be used.
In serious situations where the architecture of the uterus changes, there`s a high risk of uterine perforation and concomitant laparoscopy might be used.
Once the adherents get solved, the only issue remains to prevent them for restoring. This is performed with the use of hormonal treatments as well as placement of intrauterine devices for specific time frame.