Asherman’s syndrome is a condition where scar tissue (adhesions or synechiae) forms inside the uterus (womb) and sometimes in the cervix. In a healthy uterus, the inner lining (endometrium) thickens and sheds each month during your period. In Asherman’s syndrome, scar tissue builds up on the walls of the uterus, which can reduce the size of the uterine cavity or block it entirely.
The scar tissue can be thin and filmy or dense and thick. The severity of your symptoms depends on how much scar tissue is present and where it is located.
Causes
Asherman’s syndrome is caused by injury to the uterine lining, most often during or after pregnancy and known causes include:
- Dilatation and curettage (D&C) – performed after a miscarriage, termination of pregnancy, or to remove retained placenta after childbirth
- Removal of fibroids (myomectomy) – especially if the uterine cavity is entered
- Repeated uterine surgeries – the risk increases with each procedure
- Severe pelvic infections – such as endometritis or tuberculosis (rare in the UK)
- Caesarean section – scarring at the incision site can sometimes extend into the uterine cavity
Pregnancy makes the uterus more vulnerable to injury, so procedures performed soon after delivery or miscarriage carry a higher risk.
Symptoms
- Missed or very light periods (hypomenorrhea or amenorrhoea) after uterine surgery
- Increased period pain (dysmenorrhoea) – caused by trapped menstrual blood
- Infertility – difficulty conceiving
- Repeated miscarriages – usually in the first trimester
Why does Asherman’s syndrome matter?
The uterine lining is essential for:
- Menstrual flow – a healthy lining sheds each month
- Embryo implantation – a fertilised egg needs a healthy, unscarred surface to attach and grow
- Placental development – adequate blood supply to support a pregnancy
Scar tissue can:
- Prevent implantation – making it harder to conceive
- Reduce blood flow – leading to miscarriage or growth problems in the baby if pregnancy occurs
- Cause pain – due to trapped menstrual blood behind the scar tissue
Diagnosis
- Medical history – especially any previous uterine surgery, miscarriages, or infections
- Saline infusion sonography (hysterosonogram) – an ultrasound where sterile fluid is injected into the uterus to outline the cavity and identify scar tissue
- Hysteroscopy – the gold standard test. A thin camera (hysteroscope) is passed through the cervix into the uterus to directly visualise and map the adhesions
Treatment
The main treatment is surgery to remove the scar tissue, a procedure called Metroplasty performed via hysteroscopy. This is usually done as a day-case procedure under general or local anaesthetic.
During the operation, small instruments are passed through the hysteroscope to cut or gently divide the adhesions. The surgeon takes care to remove only the scar tissue, preserving the healthy uterine lining. After surgery, to promote healing and prevent re‑scarring:
- A small balloon may be placed inside the uterus for a few days to keep the cavity open
- You may be given oestrogen therapy (usually tablets) for several weeks to help the endometrial lining regrow
- A short course of antibiotics may be prescribed if there is any infection
Sometimes more than one procedure is needed if the adhesions are extensive or re-form.
eGynaecologist Advice
- If you have had any uterine procedure (D&C, fibroid removal, or surgery after childbirth) and your periods become unusually light, painful, or stop altogether – do not dismiss it. Seek a gynaecological assessment.
- Early diagnosis matters – the sooner adhesions are treated, the higher the chance of restoring normal uterine function and achieving a healthy pregnancy.
- Seek an experienced surgeon – hysteroscopic adhesiolysis requires skill. Ask your gynaecologist about their experience and success rates.
- Do not delay fertility treatment – if you are trying to conceive and have known risk factors for Asherman’s, consider a saline ultrasound or hysteroscopy before embarking on IVF.
Frequently Asked Questions
Can I still get pregnant with Asherman’s syndrome?
Yes – many women conceive after treatment. The chance depends on the severity of the scarring. With mild adhesions, pregnancy rates can be as high as 80% after surgery.
Will I need surgery?
Only if your symptoms bother you (pain, very light periods) or if you wish to conceive. If you have no symptoms and are not trying for a baby, surgery is not necessary.
Can the scar tissue come back after surgery?
Yes, recurrence is possible, especially in severe cases. Your gynaecologist may recommend a follow‑up hysteroscopy to check, and sometimes a temporary balloon or oestrogen therapy is used to reduce the risk of re‑scarring.
Does Asherman’s syndrome increase my risk of cancer?
No – there is no evidence that Asherman’s syndrome increases the risk of uterine or any other cancer.
Is there any medication that can dissolve the scar tissue without surgery?
No – medication alone cannot remove fibrous scar tissue. Surgery is the only proven treatment to physically divide the adhesions.
