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What is Asherman’s Syndrome?

Do you experience very light periods accompanied by severe cramping? If yes, then you are probably having Asherman’s syndrome. It is probably something you haven’t heard before. Asherman’s syndrome is a disorder with fibrous scar tissue formation (adhesions) within the uterus or cervix. This leads to blockage of the uterine cavity resulting in poor menstrual flow. Since the uterine muscles now have to work harder to release menstrual flow, cramping or pain may be experienced. Many women have no periods at all but may experience pain around the due date of their periods.

This indicates that menstruation is occurring but the flow is blocked by the adhesions. The adhesions can be thin or thick depending on the severity of the disorder. The scarring will further prevent implantation of an embryo, block the blood supply to the embryo thus leading to miscarriages. Therefore, it is one of the most common causes of female infertility. Many women with Asherman’s syndrome may not develop any symptoms at all and may remain undiagnosed.

What are the Symptoms of Asherman’s Syndrome?

Intrauterine adhesions, is a condition characterized by the formation of scar tissue within the uterus. This can lead to a variety of signs and symptoms. Here are some common signs and symptoms associated with AS:

  • Menstrual abnormalities

    One of the most common signs is changes in menstrual patterns. This may include lighter or absent periods (amenorrhea), irregular periods, or even a complete cessation of menstruation.

  • Infertility or recurrent pregnancy loss

    Asherman’s syndrome can cause infertility or recurrent miscarriages. The adhesions and scar tissue can disrupt the normal architecture of the uterus, making it difficult for a fertilized egg to implant and grow properly.

  • Pelvic pain

    Some women with AS may experience pelvic pain, especially during menstruation or sexual intercourse. The scar tissue can cause uterine cramping and discomfort.

  • Hysteroscopy findings

    Hysteroscopy, a procedure in which a thin tube with a camera is inserted into the uterus, is often performed to diagnose Asherman’s syndrome. During hysteroscopy, the presence of scar tissue, adhesions, or a thin, fibrous band can be visualized.

  • Light or absent bleeding after uterine procedures

    Women with Asherman’s syndrome may have minimal or no bleeding after undergoing uterine procedures such as dilation and curettage (D&C) or hysteroscopy. This is because the scar tissue can obstruct the normal shedding of the uterine lining.

  • Recurrent urinary tract infections (UTIs)

    In some cases, Asherman’s syndrome can be associated with recurrent UTIs. The scar tissue can create a favorable environment for bacterial overgrowth and infection.

It is important to note that the severity and presentation of Asherman’s syndrome can vary among individuals. If you suspect you may have Asherman’s syndrome, it is best to consult with a healthcare professional for proper evaluation and diagnosis.

Who is at Risk for Asherman’s Syndrome?

Any physical trauma to the uterus or the cervix will trigger the body’s wound healing process. This results in the formation of fibrous tissue or scar within the endometrium. This will lead to the front and back wall of the uterus to stick together. Women who previously had miscarriages, pelvic surgeries or caesarian sections are at an increased risk of developing AS. Usually, a D & C (Dilation and curettage) procedure performed after a miscarriage puts a patient to more than 80% risk of developing AS. Women with AS also have an increased risk of developing uterine cancers.

Treatment for Asherman Syndrome

Current treatments involve surgical interventions to remove adhesions from the uterine lining.  However, there is an increased chance of reoccurrence of the scar tissue after surgical procedures and a couple may need to wait for a year after the surgery to conceive. Also, the treatment of scarring does not guarantee the restoration of fertility. Stem cell therapy is emerging as a promising new treatment for Asherman’s syndrome. Stem cells have immense regeneration potential and have proven to be successful for treating female infertility.  Research has shown that transplantation of stem cells into patients with AS has beneficial effects such as a decline in the fibrotic scar tissue, increased thickness of the endometrium and improved pregnancy rates. Stem cells can help in restoring blood supply to the fetus which is lost in case of extensive scarring and reverse infertility issues.

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