DR MAXWELL ADEYEMI
Asherman's syndrome simply refers to the presence of scar tissue in the uterus (womb) or cervix (the opening of the uterus). It can also be called intra uterine adhesions or scarring, intrauterine synechiae, or uterine synechiae.
Asherman's syndrome is an acquired uterine condition that happens when scar tissues form inside the womb and or the cervix. This scar tissue or adhesions formed are in most cases due to some form of trauma. This scar tissue makes the uterine wall stick together and also reduces the size of the uterus.
Stages of Asherman's syndrome
The extent or degree of the adhesions determines if the case is mild, moderate, or severe. The scar tissues can either be thin or thick, spotty in location, or confluent. They are usually not vascular, which is an important attribute that helps in its diagnosis and treatment.
Stage 1 - the scarring involves a mild scar in either the cervical canal or uterine cavity. The scar may or may not involve the very low end of uterine cavity which might result in significant impact in the function of the endometrium. However, if the low end of the uterine cavity is not involved, there would be a little impact on normal function of the uterus.
Stage 2 - the scarring involves a moderate scar at the very low end of uterine cavity. There will be no production of menstrual blood and no pain. Some women may experience little cramps with no bleeding at all.
Stage 3 - in this case, more than half of the uterus is blocked by scar tissue, also one of the fallopian tubes may also be obstructed. It is much more difficult to achieve clinical pregnancy in this stage.
Stage 4 - the scarring occupies more than half of the uterus and causes a reduction in the size of the uterus. It is almost impossible to achieve clinical pregnancy in this stage and treatment might include multiple corrective surgeries. This is usually referred to as "unstuck Asherman's" and is usually caused by endometrial changes (sclerosis), more than dilatation and curettage.
Causes
Asherman's syndrome is relatively common in women who have had several dilatation and curettage (D&C) or 'scraping' procedures, either as elective abortion, repeated abortions or because of a missed or incomplete miscarriage. It most often develops after uterine surgeries with scar tissues formed after some pelvic surgeries such as: Caesarean section, myomectomy surgery for uterine fibroid removal, and polyps surgery removal of abnormal tissue growth on a mucous membrane.
A severe pelvic infection (infection of the reproductive organs) or inflammation unrelated to surgery such as genital tuberculosis (tuberculosis affecting fallopian tubes) and schistosomiasis (an infection caused by parasitic worms) may also lead to Asherman's syndrome.
It may also be caused by radiation treatment.
Symptoms
Most women with Asherman's syndrome suffer hypomenorrhea - very light periods - or amenorrhea - no periods at all. Some women have pain at the time that their period should be due, b
