Uterine Adhesions and Scarring

Uterine adhesion, orAsherman’s syndrome or intrauterine synechiae, occurs when scar tissue forms and builds up inside the uterus. Surgical procedures, some health conditions, and infections can cause scar tissue on and near the uterine walls. As uterine scar tissue accumulates, it can decrease the uterus’s space, causing concerns such as uterine pain, infertility or recurrent pregnancy loss, and abnormal bleeding.

What are uterine adhesions?

The inside of the uterus is similar to a balloon, with the front and back walls usually lying flat against each other. The inside is lined with endometrium tissue that serves various purposes for menstruation and reproduction.

During menstruation, the endometrium’s superficial (top) layer is shed. When you become pregnant, the embryo implants in the endometrium, and it helps develop the placenta.

The endometrium also helps the uterus remain an open cavity and prevents adhesions between the walls. However, injuries or infections can damage the uterine lining and cause the formation of intrauterine adhesions (IUA) between the inner walls of the uterus. These types of uterine abnormalities, the walls adhering or sticking to each other, are also known as Asherman’s syndrome.

The scarring can be mild, with thin, stretchy bands of scar tissue, or severe, with the formation of thick bands. In the most severe cases of Asherman’s syndrome, partial or total occlusion (blockage) of the inside of the uterine cavity can occur. The need to treat Asherman’s syndrome depends on the severity of the adhesions.

Causes of uterine adhesions

The causes of Asherman’s Syndrome are usually related to damage to the uterine tissue. However, the precise cause of a patient’s adhesions is sometimes unknown.

The most common cause of uterine adhesions is an injury following a surgical gynecology procedure that involves the cavity of the uterus.

For example, dilation and curettage is a common outpatient surgical procedure during which the cervix is stretched, and the tissue contents of the uterus are removed. The procedure is often performed after pregnancy complications, such as retained placenta, miscarriage, or placenta accreta.

Other procedures involving the uterus that may lead to adhesions include the surgical removal of fibroids or endometrial polyps in the cavity of the uterus, cesarean sections, and endometrial ablation (a surgical procedure that is used to intentionally damage the uterine lining to make menstrual periods lighter or eliminate menstrual flow). Because these procedures can be somewhat traumatic to the tissue of the uterus, scar tissue and subsequent adhesions may develop.

Other than uterine surgery, other risk factors for adhesion formation are infections of the uterine lining (endometritis) due to things like genital tuberculosis or a severe pelvic infection,endometriosis, severe postpartum hemorrhage, or biopsies for uterine cancer.

Symptoms of Asherman’s Syndrome

Although scar tissue formation is a normal part of the healing process, adhesions can be problematic because they cause body parts not normally connected to stick together.

For example, the intestine may become connected by adhesions to the uterus, or the fallopian tube may stick to the ovary. Scar tissue is very tough and lacks the flexibility and elasticity of normal tissue. Some women experience no uterine adhesion symptoms at all, but when adhesions impair the normal movement of the pelvic organs, pain can result. The most common symptoms of Asherman’s syndrome include:

• Very light periods (hypomenorrhea) or no periods (amenorrhea). This can occur if scar tissue replaces the endometrium so that it can no longer break down and bleed during a normal menstrual cycle. Occasionally, scar tissue blocks the cervical opening, stopping menstrual blood flow.
• Pelvic pain and severe menstrual cramping
• Difficulty getting pregnant or recurrent miscarriage. Uterine scarring lowers one’s ability to get pregnant because it decreases the blood supply to the endometrial lining.

Diagnosing uterine adhesions

If you have these symptoms, our doctor can help determine their cause. Visualization of uterine scarring is often done with imaging like sonography. Common diagnostic procedures include:

• Hysterosalpingogram (HSG). Hysterosalpingography involves injecting contrast dye into the uterine cavity and then performing an X-ray of the pelvis to view patency, which means how open the uterine cavity is.
• Pelvic ultrasound. Ultrasounds can be done transvaginally or transabdominally to view the uterine cavity and measure the thickness of the endometrium. In some cases, a saline sonogram, an ultrasound in which sterile water is injected into the uterus, may be used.
• Hysteroscopy. Inhysteroscopic surgery, a thin, flexible, lighted telescope into the vagina and through the cervix to view the inside of the uterus directly.
• Biopsy. A small sampling of the uterine lining is taken to test whether you still have any normal endometrial tissue.

Treatment for Asherman’s Syndrome

If your adhesions aren’t causing you any pain and you’re not planning on getting pregnant in the future, you may not need treatment at all. You can talk with Dr. Aliabadi about your options and the implications of non-treatment. Treatment options generally involve breaking up the scar tissue and preventing it from reforming to improve reproductive outcomes and manage discomfort or abnormal bleeding.

To remove the scar tissue, our gynecologist may perform hysteroscopic adhesiolysis of adhesions. This is an outpatient procedure in which Dr. Aliabadi uses a hysteroscope to view the lining of the uterus and agitate any scar tissue that’s present. If the scar tissue is sparse and filmy, she may be able to use the hysteroscope itself to break it apart. If it’s significantly denser, surgical scissors can be used during uterine adhesion removal.

To prevent the scar tissue from returning, Dr. Aliabadi may recommend the following: 

Have questions about your health? Talk to Dr. Aliabadi

Dr. Aliabadi and her compassionate team are experts in women’s health care and the conditions women may experience, including uterine adhesions. When you’re treated by Dr. Aliabadi, you’re guaranteed to feel safe, heard, and well cared for.

We invite you to establish care with Dr. Aliabadi. Pleasemake an appointment online or call us at (844) 863-6700.

The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.

Uterine adhesions FAQs

Can uterine adhesions be cancerous?

Uterine adhesions are scar tissue and, therefore, are not cancerous. However, adhesions can be a complication of uterine cancer or cancer treatments.

Can uterine adhesions cause infertility?

In some cases, uterine adhesions can contribute to infertility. They can cause blockages within the uterus and form around the ovaries or fallopian tubes, impairing or preventing conception.

How to prevent uterine adhesions?

While there is no guaranteed way to prevent uterine adhesions, doctors can take steps to decrease the chances of scar tissue after operations concerning the uterus, such as inserting a balloon to keep the uterus open, prescribing hormonal birth control with estrogen, or recommending medications to aid healing.

Sources

Smikle, C. (2023, July 24). Asherman syndrome. StatPearls [Internet]
https://www.ncbi.nlm.nih.gov/books/NBK448088/

Zheng F, Xin X, He F, Liu J, Cui Y. Meta-analysis on using hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations. Exp Ther Med. 2020 Apr;19(4):2672-2678. doi: 10.3892/etm.2020.8483. Epub 2020 Feb 3. PMID: 32256748; PMCID: PMC7086218.