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

Asherman’s syndrome is an acquired condition where scar tissue—mathematically referred to as intrauterine adhesions—develops inside the uterine cavity. This scar tissue can vary in severity; in mild cases, it may involve small bands of tissue, while in severe cases, the front and back walls of the uterus may stick together almost entirely.

Because the uterine lining (the endometrium) is replaced by this fibrous scar tissue, it cannot thicken as it normally would during a menstrual cycle. This leads to the hallmark symptoms of the condition: amenorrhoea (absent periods) or hypomenorrhoea (unusually light periods). For many women in the UK, the condition is first suspected when their monthly cycle fails to return to normal following a gynaecological procedure.

The symptoms of Asherman’s syndrome are often subtle and depend heavily on how much of the uterine cavity is affected by scarring. Common signs include:

• Changes in Menstruation: Periods may become significantly lighter, shorter, or stop completely. If the cervix is blocked by scar tissue but the rest of the lining is still shedding, you may experience severe monthly cramping without any visible bleeding.
• Difficulty Conceiving: Intrauterine adhesions can prevent a fertilised egg from implanting properly in the uterine wall.
• Recurrent Miscarriage: If pregnancy does occur, the lack of healthy endometrial tissue can lead to early pregnancy loss.
• Cyclical Pelvic Pain: Occurs if blood or tissue is trapped within the uterus by the adhesions.

It is important to note that some women with mild adhesions may have no visible symptoms and only discover the condition during investigations for infertility.

In the majority of cases, Asherman’s syndrome is a complication of uterine surgery. According to NHS and NICE frameworks, the most common trigger is a Dilation and Curettage (D&C), particularly one performed to manage a miscarriage or to remove retained placenta after childbirth. If the basal layer of the endometrium is damaged during the procedure, it can trigger an inflammatory response that creates scar tissue.

Other potential causes include:

• Uterine surgeries such as myomectomy (removal of fibroids) or caesarean sections.
• Infections of the uterus, for example, pelvic inflammatory disease (PID) or, more rarely, genital tuberculosis.
• Endometrial ablation, which is a procedure specifically designed to scar the lining to treat heavy periods.

Asherman's syndrome cannot be diagnosed through a simple physical examination. In the UK, the ‘gold standard’ for diagnosis is a hysteroscopy. This involves a specialist inserting a small camera through the cervix to look directly at the uterine walls. Other diagnostic tools include a saline infusion sonogram (SIS) or an HSG (hysterosalpingogram), where dye is used to highlight the shape of the uterine cavity on an X-ray.

UK specialists generally categorise the condition into stages, from mild to severe, based on the extent of the adhesions and the health of the remaining endometrial lining. Early diagnosis is vital for those hoping to conceive in the future.

If you have noticed that your periods have become significantly lighter or have disappeared following a miscarriage, childbirth, or uterine surgery, you should seek medical advice. Speaking to an online doctor in the UK can be a helpful first step in discussing your symptoms in a calm, private environment.

An online GP can review your medical history, discuss the timeline of your symptoms, and explain the next steps for referral to a gynaecologist for a hysteroscopy. They can also provide a sick note if you are experiencing significant pelvic pain that interferes with your work, or offer advice on managing the emotional impact of fertility concerns while you wait for specialist secondary care.

Treatment is primarily surgical and aims to remove the scar tissue to restore the shape and function of the uterus. This is typically performed via operative hysteroscopy, where the surgeon uses microminiature instruments to cut away the adhesions. To prevent the scars from reforming, a surgeon might temporarily place a small balloon or coil inside the uterus or prescribe a course of oestrogen therapy to encourage the healthy lining to regrow.

The prognosis for restoring menstruation is generally excellent for mild and moderate cases. For those seeking to get pregnant, success rates depend on the severity of the initial scarring and the health of the underlying endometrium. Follow-up scans are often required to ensure the cavity remains open.