Asherman syndrome is a rare condition that occurs when scar tissue forms and builds within the uterus. It can cause mild to severe symptoms and complications, including infertility.

Asherman syndrome is an acquired gynecological condition. It often occurs following procedures such as dilation and curettage (D&C), where doctors remove tissues from the uterus.

When Asherman syndrome occurs, scar tissue or adhesions build up within the uterus. The buildup causes the space in the uterus to shrink.

The narrowed space can cause several symptoms and can lead to infertility in severe cases.

This article reviews Asherman syndrome and its potential symptoms, causes, treatments, and more.

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This feature mentions pregnancy loss, stillbirth, or both. Please read at your own discretion.

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An illustrated diagram showing the difference between a normal uterus and a uterus with Asherman syndrome.Share on Pinterest
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Asherman syndrome is a rare gynecological condition. It occurs when scar tissue forms and builds up within the uterus.

People may also refer to Asherman syndrome as:

  • intrauterine adhesions (IUA)
  • uterine synechiae
  • intrauterine synechiae

It is not clear how many people the condition affects. In part, this may be due to unreported cases. People not trying to conceive may not notice symptoms associated with the condition, which can lead to skewed numbers.

Some estimates for prevalence are:

  • about 13% of people receiving an abortion in the first trimester
  • about 30% of people undergoing a D&C after a late pregnancy loss
  • about 23.4% of people undergoing procedures 2–4 weeks after the initial procedure for a vaginal delivery or missed abortion

Symptoms can vary. Some people — particularly those not looking to conceive — may not notice any symptoms.

Common symptoms can include:

  • repeated pregnancy loss
  • amenorrhea, a lack of menstrual periods
  • infertility
  • painful periods
  • a blockage of the uterus or cervix causing retrograde menstruation, where blood flows up the fallopian tubes rather than out of the body

Though these symptoms could indicate several other, more common issues, a doctor may suspect Asherman syndrome if they occur suddenly following a D&C or other uterine procedure.

The most common cause of the rare condition is repeated trauma to the uterus from surgical scraping or cleaning of the uterine wall, such as in a D&C procedure.

Doctors commonly perform a D&C following an abortion or pregnancy loss to help clean and clear the uterine lining or to treat heavy menstrual bleeding.

A D&C procedure is the most common risk factor for Asherman syndrome.

Other possible causes or risk factors include:

Several conditions can present with similar symptoms to Asherman syndrome.

Some examples include:

  • Primary amenorrhea: The absence of menstruation by the age of 15 or 3 years following breast development.
  • Secondary amenorrhea: This can occur in cases of Asherman syndrome. It is the absence of more than three cycles in those who have had previous menstrual cycles.
  • Pelvic inflammatory disease (PID): An infection of the uterus, ovaries, fallopian tubes, or cervix. Professionals mainly associate PID with sexually transmitted infections (STIs) and abortion.
  • Endometriosis: A prevalent inflammatory condition that involves the female reproductive system. Some professionals associate endometriosis with the development of Asherman syndrome.
  • Polycystic ovarian syndrome (PCOS): A condition that causes unusual or absent menstruation and can lead to infertility.

Learn more about PCOS.

To receive a diagnosis, a person will need to visit a doctor. The doctor will likely perform imaging examinations to look at the size and shape of the uterus.

Currently, the best diagnostic method is a hysteroscopy. A hysteroscopy involves attaching a camera to an instrument to insert into the uterus. The photographs can show any scar tissue or IUA inside the uterus.

However, not all facilities have the resources for a hysteroscopy. This may lead to misdiagnosis.

Another method doctors may use is hysterosalpingography. This specialized imaging test uses an X-ray and contrast dye to show a picture of the uterus and possible scar tissue.

Other imaging tests, such as ultrasound and MRI, cannot detect the presence of Asherman syndrome. However, an ultrasound may be able to detect signs that suggest Asherman syndrome.

The following images show what Asherman syndrome can look like.

IUA are areas of fibrous tissue that form in the uterine cavity.

The number of IUA often correlates with the severity of the condition, so more IUA generally means worsening symptoms.

Treatment typically includes one or more of the following procedures:

  • Hysteroscopic surgery: This is the most common treatment. Surgeons use an instrument to cut the adhesions from the uterine wall. This is often an outpatient procedure.
  • Hormone therapy: Estrogen may help the uterine cells to heal and rebuild.
  • Antibiotics: Using antibiotics does not directly help with Asherman syndrome, but it may help prevent infection and inflammation following a hysteroscopic surgery.

Additionally, a doctor may recommend measures to prevent scar tissue buildup. This may include:

  • insertion of a Foley catheter to keep the uterine walls separated
  • insertion of a uterine balloon stent to also keep the uterine walls separated
  • use of certain chemicals to help prevent scar formation, such as hyaluronic acid

Researchers may develop new treatment methods in the future. For example, researchers are currently investigating stem cell transplants to rebuild the uterine lining.

Once treated, a person with Asherman syndrome should fully recover.

Assuming no other issues affect their fertility, they should be able to conceive after treatment. Reassessment 1–2 weeks post-treatment may allow doctors to identify and treat any signs of recurrence before the condition worsens.

Some experts warn that people who have had Asherman syndrome should receive routine sonography to check for the development of endometrial cancer before or after menopause.

Asherman syndrome can cause several complications, many of them related to fertility and pregnancy.

Some potential complications include:

  • repetitive pregnancy loss
  • low birth weight
  • missed development of endometrial cancer
  • preterm labor
  • placental complications, such as retained placenta and placenta accreta

A person should consider consulting a doctor if they experience symptoms associated with Asherman syndrome, such as:

  • repeated pregnancy loss
  • abnormal menstrual bleeding
  • pain associated with menstruation

The Centers for Disease Control and Prevention (CDC) recommend that females under 35 years old should contact a doctor if they have been trying to conceive after 1 year with no results.

Females over 35 should consult a doctor after 6 months of trying to conceive with no results.

Though Asherman syndrome is not the most likely cause, a doctor can help determine what is causing the issue.

Other reasons to contact a doctor include having had a recent D&C and developing symptoms associated with Asherman syndrome.

The following section provides answers to common questions about Asherman syndrome.

Can people prevent Asherman syndrome?

There is no way for a person to prevent Asherman syndrome.

People at an increased risk of Asherman syndrome, such as those who have undergone a D&C one or more times, should consider talking with a doctor if they develop symptoms associated with the condition.

How common is Asherman syndrome?

Experts consider Asherman syndrome to be a rare condition.

Even people with risk factors, such as multiple D&C procedures, may not develop the condition. It is unclear why some people develop Asherman syndrome, and some do not.

Can people get pregnant with Asherman syndrome?

It is possible for a person with Asherman syndrome to become pregnant. However, the condition can make it very difficult.

Asherman syndrome can lead to repeated pregnancy loss. For some people, blockages may prevent pregnancy altogether.

A person should consider talking with a doctor if they have difficulty conceiving for more than 1 year if they are under 35 years old or 6 months if they are over 35.

Asherman syndrome is a rare, acquired gynecological condition that professionals associate with a buildup of scar tissue in the uterus.

For some people, symptoms are mild or nonexistent, while others may experience menstrual cycle disruption and pregnancy issues, including infertility.

Treatment can typically cure the condition. Once cured, a person should have no prolonged issues associated with the condition.