Asherman syndrome

Asherman syndrome, also known as intrauterine adhesions (IUA) or intrauterine synechiae, is an acquired condition characterized by the formation of scar tissue (adhesions) within the uterine cavity. These adhesions can partially or completely obliterate the endometrial cavity, leading to disruption of normal endometrial function. The condition most commonly develops following uterine surgical procedures, particularly dilation and curettage (D&C) performed after miscarriage, delivery, or elective termination of pregnancy. It can also occur after other uterine surgeries such as cesarean section, myomectomy, or following endometrial infections such as genital tuberculosis. The primary body system affected is the female reproductive system. Key clinical features include menstrual abnormalities ranging from hypomenorrhea (abnormally light periods) to secondary amenorrhea (complete absence of menstruation), recurrent pregnancy loss, infertility, and cyclic pelvic pain caused by trapped menstrual blood behind adhesions. The severity of symptoms correlates with the extent and location of the adhesions within the uterine cavity. Diagnosis is typically confirmed by hysteroscopy, which is considered the gold standard and allows direct visualization of the adhesions. Other diagnostic tools include saline infusion sonohysterography and hysterosalpingography. Treatment primarily involves hysteroscopic adhesiolysis — the surgical division of adhesions under direct visualization. Following surgery, strategies to prevent adhesion reformation include placement of intrauterine devices or balloon stents, hormonal therapy with estrogen to promote endometrial regeneration, and the use of anti-adhesion barriers. Despite treatment, recurrence of adhesions is common, particularly in severe cases, and reproductive outcomes depend on the severity of the original disease. Emerging therapies including stem cell treatments and platelet-rich plasma are under investigation to improve endometrial regeneration.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

Common questions about Asherman syndrome