Uterine adhesions and scaring are essentially areas of scar tissue on the uterus. Adhesions are also known as Asherman’s syndrome, and can vary in their severity and need for treatment.
Symptoms of Uterine Adhesions
In some cases, adhesions cause no symptoms at all, but the most common symptoms include:
- Very light periods or no periods (amenorrhea). This can occur if scar tissue is replacing the endometrium, which is the tissue that breaks down and bleeds during a normal menstrual cycle. Occasionally, scar tissue blocks the cervical opening, stopping the flow of menstrual blood.
- Pelvic pain and severe menstrual cramping
- Difficulty getting pregnant or recurring miscarriage
If you have these symptoms, you should make an appointment with your doctor. We can perform a hysteroscopy to examine the uterine lining and check for adhesions. A hysteroscopy is a procedure in which we insert a thin, flexible, lighted telescope into the vagina and through the cervix to directly view the inside of the uterus.
We may also perform a transvaginal ultrasound to measure the thickness of your endometrium, and a biopsy of the uterine lining to test whether you still have any normal endometrial tissue.
Causes of Uterine Adhesions
Uterine adhesions are usually caused by damage to the uterine tissue, such as:
- D&C (dilation and curettage) for heavy bleeding, miscarriage, abortion, or any other purpose
- Curettage for post-delivery complications such as removal of the placenta or hemorrhaging
- Uterine surgeries
- Infection of the uterus or pelvis
- Pelvic tuberculosis – more common in developing nations
However, sometimes the precise cause of a patient’s adhesions is unknown.
Treatment for Uterine Adhesions
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 your OB-GYN about your options and the implications of non-treatment. Treating adhesions of the uterus generally involves breaking up the scar tissue and trying to prevent scar tissue from reforming in its place.
To remove the scar tissue, your gynecologist may perform hysteroscopic lysis of adhesions. This is an outpatient procedure in which the doctor uses a hysteroscope to view the lining of the uterus and agitate the scar tissue that’s present. If the scar tissue is sparse and filmy, the doctor may be able to use the hysteroscope itself to break it apart. If it’s significantly denser, surgical scissors can be used.
Scar tissue can be prevented from growing again in a few different ways:
You may be prescribed a 30-day regimen of oral estrogen to help the uterus clear itself of its old tissue and regrow a healthy endometrium.
An inflated medical balloon or an IUD placed in the cavity of the uterus can help the uterus regrow normal tissue.
Typically, your doctor will schedule you for a second or third hysteroscopy after about a week or two following the previous one. This is to break up any remaining scar tissue and ensure that all of the scar tissue has been removed.
Recovery from hysteroscopic lysis of adhesions can vary, although most women get their normal period again, are able to become pregnant, and are able to carry the pregnancy to term.
If you believe you are experiencing symptoms of, or suffering from Uterine Adhesions and Scaring, or have questions about it, please see your doctor.
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