Asherman's Syndrome: A Comprehensive Overview
Asherman's syndrome is a rare condition that affects the reproductive system of women. It occurs when scar tissue, also known as adhesions, forms inside the uterus and/or the cervix. The scar tissue can reduce the size of the uterine cavity and interfere with the normal functioning of the endometrium, the lining of the uterus. Asherman's syndrome can cause various symptoms and complications, such as abnormal or absent menstrual bleeding, pelvic pain, infertility, and pregnancy problems.
What Causes Asherman’s Syndrome?
The main cause of Asherman's syndrome is damage to the endometrium due to surgery, infection, or cancer treatment. The most common surgical procedure that can lead to Asherman's syndrome is dilation and curettage (D&C), which is used to remove tissue from the uterus after a miscarriage, abortion, or delivery. Other procedures that can injure the endometrium include caesarean section (C-section), myomectomy (removal of uterine fibroids), hysteroscopy (inspection of the uterine cavity), and endometrial ablation (destruction of the endometrium to treat heavy bleeding). Infections that can affect the endometrium include pelvic inflammatory disease (PID), endometritis (inflammation of the endometrium), and genital tuberculosis. Cancer treatments such as radiation therapy and chemotherapy can also damage the endometrium.
Diagnosis of Asherman’s Syndrome
The diagnosis of Asherman's syndrome can be challenging because some women may not have any symptoms or may have normal periods. However, some signs that may indicate Asherman's syndrome include:
- Hypomenorrhea: very light or scanty menstrual bleeding.
- Amenorrhea: absence of menstrual bleeding for more than six months.
- Dysmenorrhea: painful menstrual cramps.
- Infertility: difficulty conceiving or carrying a pregnancy to term.
- Recurrent miscarriage: loss of two or more consecutive pregnancies before 20 weeks of gestation.
- Placental abnormalities: problems with the attachment or development of the placenta, such as placenta previa (low-lying placenta), placenta accreta (abnormal invasion of the placenta into the uterine wall), or retained placenta (incomplete expulsion of the placenta after delivery).
To confirm the diagnosis of Asherman's syndrome, a doctor may perform one or more of the following tests:
- Hysterosalpingography (HSG): an X-ray examination of the uterus and fallopian tubes using a contrast dye that is injected through the cervix.
- Sonohysterography (SHG): an ultrasound examination of the uterus using saline solution that is injected through the cervix.
- Hysteroscopy: a visual examination of the uterine cavity using a thin, flexible instrument called a hysteroscope that is inserted through the cervix.
- Magnetic resonance imaging (MRI): a non-invasive imaging technique that uses radio waves and a magnetic field to create detailed pictures of the internal organs.
How to Treat Asherman’s Syndrome
The treatment of Asherman's syndrome depends on the severity and location of the adhesions, as well as the patient's reproductive goals. The main treatment option is surgery to remove or cut the scar tissue and restore the normal shape and size of the uterine cavity. This can be done using hysteroscopy or laparoscopy (a minimally invasive technique that uses small incisions and a camera). After surgery, a doctor may prescribe hormonal therapy, such as oestrogen or progestin, to stimulate the growth of new endometrial tissue and prevent recurrence of adhesions. A doctor may also insert a device, such as a balloon catheter or an intrauterine device (IUD), inside the uterus to keep it open and prevent reformation of scar tissue. Antibiotics may be given to prevent infection.
The prognosis of Asherman's syndrome varies depending on several factors, such as the extent and location of adhesions, the quality of surgery, and the age and health status of the patient. In general, women who have mild to moderate adhesions confined to the lower part of the uterus have a better chance of restoring their menstrual function and fertility than those who have severe adhesions involving the upper part of the uterus or both sides of it. The success rate of pregnancy after surgery ranges from 40% to 80%, depending on these factors. However, women who have Asherman's syndrome are at increased risk of complications during pregnancy and delivery, such as preterm labour, intrauterine growth restriction (IUGR), low birth weight, bleeding, and caesarean delivery.
Asherman's syndrome is a rare but serious condition that can affect women's reproductive health and quality of life. It is important to seek medical attention if you experience any symptoms suggestive of Asherman's syndrome or have a history of risk factors for developing it. Early diagnosis and treatment can improve your chances of having a normal menstrual cycle and a successful pregnancy.
Sources
- Debbo Africa: https://debbo.africa
- Asherman’s Syndrome: What Is It, Symptoms & Treatment - Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16561-ashermans-syndrome
- Asherman's syndrome - Wikipedia. https://en.wikipedia.org/wiki/Asherman%27s_syndrome
- Asherman syndrome: Symptoms, causes, and more - Medical News Today. https://www.medicalnewstoday.com/articles/asherman-syndrome
- International Asherman's Association – Asherman's syndrome information and support. https://ashermans-support.org/
- Asherman Syndrome: Causes, Symptoms, and Treatment - WebMD. https://www.webmd.com/women/what-is-asherman-syndrome