Asherman’s Syndrome: Symptoms, Causes, and Support in the UK

Asherman’s syndrome, also known as intrauterine adhesions (IUA), is a condition where scar tissue (adhesions) builds up inside the uterine cavity. This scarring can range from thin strands of tissue to thick, dense bands that make the walls of the uterus stick together. In severe cases, the entire uterine cavity may be obliterated.

In the UK, this condition is relatively rare but can have a profound impact on a woman's reproductive health. The scar tissue disrupts the normal function of the endometrium (the lining of the womb), which is necessary for a regular menstrual cycle and for a fertilised egg to implant. Because it is an acquired condition—meaning you aren't born with it—it usually follows some form of trauma or infection within the womb.

The symptoms of Asherman’s syndrome vary significantly depending on the extent of the scarring. Some women may be completely asymptomatic, while others experience life-altering changes to their reproductive cycle. Common signs include:

• Amenorrhoea: Your periods stop entirely, even though you are not pregnant or menopausal.
• Hypomenorrhoea: Your periods become significantly lighter or shorter than they used to be.
• Cyclical Pelvic Pain: You may feel period-like cramping every month, but no blood actually leaves the body because it is trapped by scar tissue.
• Difficulty Conceiving: Struggling to get pregnant (infertility) despite regular unprotected intercourse.
• Recurrent Miscarriage: Frequent early pregnancy loss can sometimes be linked to an unhealthy uterine lining.

It is important to note that if you have had a recent uterine procedure and notice your periods have not returned, you should seek advice from a healthcare professional.

According to clinical evidence reviewed by the NHS, the most frequent cause of Asherman’s syndrome is damage to the uterine lining following surgery. This is most common after a Dilation and Curettage (D&C), which is a procedure to clear the womb after a miscarriage or to remove retained placenta after childbirth.

Other potential causes include:

• Complications from a Caesarean section.
• Surgery to remove uterine fibroids (myomectomy).
• Infections like Pelvic Inflammatory Disease (PID) or, more rarely in the UK, genital tuberculosis.
• Endometrial ablation, a procedure specifically designed to thin the womb lining for women with heavy periods.

The risk is higher if the surgery is performed while the woman has an active infection or if the D&C is performed very soon after a pregnancy when the uterine walls are particularly soft.

Routine pelvic examinations and standard ultrasounds often fail to detect Asherman’s syndrome. If you report symptoms of absent periods or fertility issues following surgery, a UK specialist will typically recommend more detailed investigations. The 'gold standard' for diagnosis is a hysteroscopy.

Hysteroscopy

During a hysteroscopy, a thin telescope-like camera is inserted through the cervix into the womb. This allows the consultant to see the extent and location of the scar tissue directly. Other tests might include a Hysterosalpingogram (HSG), where dye is injected into the uterus and tracked via X-ray to identify blockages, or a saline infusion sonogram (SIS).

Treatment is primarily surgical and aims to remove the scar tissue to restore the womb's normal shape and function. This is usually done via operative hysteroscopy, where the surgeon clips or lasers the adhesions away while viewing them through the camera.

Following the procedure, your doctor might recommend:

• Hormone Therapy: High doses of oestrogen are often prescribed for several weeks to encourage the healthy regrowth of the uterine lining and prevent new scars from forming.
• Intrauterine Balloons: A small balloon or a copper-free coil may be placed inside the womb temporarily to keep the walls apart during the initial healing phase.
• Follow-up Scans: Periodic checks to ensure the scars have not returned.

While minor cases have an excellent prognosis for restoring regular periods and fertility, severe cases may require multiple surgeries.

If you have noticed a sudden change in your menstrual cycle following a miscarriage, birth, or uterine surgery, you should speak to a GP online or in person. Many women feel that 'lighter periods' are simply a part of age or recovery, but if they are accompanied by pain or a complete lack of bleeding, it warrants investigation.

An online doctor can review your medical history, discuss the timeline of your symptoms, and provide a private referral to a gynaecologist for a hysteroscopy. Seeking help early can prevent the scarring from becoming more dense over time, which improves the chances of successful treatment. If you are trying to conceive and have a history of uterine procedures, an online consultation is a calm, factual first step in your fertility journey.