Intrauterine Adhesions (Asherman’s Syndrome): Symptoms & UK Treatment Guide

Intrauterine adhesions, historically known as Asherman’s Syndrome, is an acquired condition where scar tissue forms within the cavity of the uterus. This tissue can cause the walls of the uterus to stick together, reducing the volume of the cavity and potentially blocking the cervical canal or the openings to the fallopian tubes.

In the UK, this condition is frequently linked to previous gynaecological procedures. While the uterus is a resilient organ, the basal layer of the endometrium (the uterine lining) can sometimes be damaged during surgery or due to inflammation. When this layer is compromised, it may not regrow normally, leading to the formation of fibrous bands. According to NICE clinical pathways, managing uterine health is a critical component of reproductive medicine, as scarring can significantly impact both menstruation and fertility.

The symptoms of intrauterine adhesions can vary significantly depending on the extent of the scarring. For some women, the condition is asymptomatic and only discovered during investigations for infertility. However, most women experience changes to their menstrual cycle.

• Hypomenorrhoea: Periods that have become notably lighter or shorter in duration than they were previously.
• Amenorrhoea: The complete absence of periods, despite not being pregnant or menopausal.
• Cyclic Pelvic Pain: Pain that occurs around the time a period is expected, but without significant bleeding; this happens if the blood is trapped behind scar tissue.
• Recurrent Miscarriage: Difficulty maintaining a pregnancy due to the restricted space or poor lining within the uterus.
• Infertility: Difficulty conceiving after 12 months of regular unprotected intercourse.

It is important to note that if you have recently had a procedure such as a Dilatation and Curettage (D&C) or surgery for fibroids, any subsequent change in your menstrual flow should be discussed with a healthcare professional.

The most common cause of intrauterine adhesions in the UK is trauma to the uterine lining. This typically occurs during or after gynaecological surgery. The risk is higher if the surgery is performed while the lining is thin or if there is a concurrent infection.

Surgical Trauma

Procedures such as D&C for a miscarriage or following childbirth (to remove retained placenta) are the primary triggers. Other surgeries include the removal of uterine fibroids (myomectomy) or polyps. Statistics suggest that the risk increases with the number of D&C procedures a woman has undergone.

Infection

Inflammation of the uterine lining, known as endometritis, can lead to scarring. This may be caused by Pelvic Inflammatory Disease (PID) or complications following a caesarean section. In some global contexts, tuberculosis of the genital tract is a cause, though this is less common in the UK.

Diagnosing intrauterine adhesions requires specialised imaging because a standard pelvic ultrasound often appears normal. If you speak to a GP online or in person, they will typically refer you to a gynaecologist for further testing.

• Hysteroscopy: Considered the 'gold standard', a small camera is inserted through the cervix to allow the doctor to see the scar tissue directly.
• Hysterosalpingogram (HSG): An X-ray procedure where dye is injected into the uterus to check for blockages or irregularities in the shape of the cavity.
• Saline Infusion Sonogram (SIS): A specialised ultrasound where saline is used to expand the uterine cavity, making adhesions easier to detect.

Following NHS guidance, these tests are usually prioritised if there is a history of uterine trauma combined with secondary amenorrhoea or infertility.

The goal of treatment is to remove the adhesions and restore the normal shape and function of the uterus. This is particularly important for women who wish to conceive in the future.

Hysteroscopic Adhesiolysis

The primary treatment is a surgical procedure where a gynaecologist uses a hysteroscope to guide the cutting of the scar tissue. This is usually performed under general or local anaesthetic. Modern techniques involve using tiny scissors or lasers to minimise further trauma to the healthy lining.

Post-Operative Care

To prevent the scars from reforming, a doctor might place a small balloon or a copper-free intrauterine device (IUD) inside the uterus for a few weeks. Hormone therapy, typically oestrogen, may also be prescribed to encourage the healthy regrowth of the uterine lining. A follow-up hysteroscopy is often recommended to ensure the cavity remains clear.

If you are concerned about changes to your periods or are struggling to conceive, you can speak to a GP online to discuss your medical history and symptoms. An online GP consultation is a convenient way to get an initial assessment, especially if you have had recent surgery and noticed a change in your cycle.

During a digital appointment, the doctor can help determine if your symptoms warrant a referral to a gynaecology specialist. They can also provide advice on managing pelvic pain and discuss the potential impact of uterine scarring on your long-term reproductive health. Seeking early advice is the best way to ensure that any physical changes are investigated promptly, keeping you aligned with NICE guidelines for menstrual and fertility health.