Causes

Mostly cases of Asherman’s syndrome are connected with infections, miscarriages, post-surgical complications, particularly involving abortion, as well as operations in the uterine cavity and endometrial polyps’ removal.

Statistically, every third woman who had an induced abortion is at high risk of such pathology formation which leads to fertility problems. Asherman’s syndrome is formation of scar tissue inside the cervix and uterus.

In majority cases such abnormal formations can be caused by the following: use of intrauterine device, genital tuberculosis, endometritis, and also it can be congenital susceptibility for dense scars development.

Women who went through a dilation and curettage procedure (known as “D&C”) has also a risk to face with Asherman’s syndrome. This procedure is applied after the natural birth of a child for the placenta removal. However, some surgeons believe that not every “D&C” causes Asherman’s syndrome but it can happen only in cases when doctor operates uterine walls with too sharp instruments.

There is also an opinion that laser pelvic therapy can also trigger the appearance of scar tissue. The radiotherapy affects the blood flow to the uterus in consequence of which the ovaries can produce less estrogen, which will lead to uterine synechiae.

Asherman’s Syndrome

Study shows repeated D&C increases risk of developing Asherman’s Syndrome. A study, published in Human Reproduction, evaluated 50 women ages 19-44, through hysteroscopy, to determine the presence of uterine adhesions after a required second D&C due to either remaining placental remnants following delivery, missed miscarriage or medical abortion. Of the 50 women, 20 (40%) had developed intrauterine adhesions. Of that 40%, 75% had developed grade II-IV, grade IV being the most severe.

Surgical procedures that may lead to Asherman’s Syndrome:

  • D&C for miscarriage, incomplete or missed
  • D&C for retained placenta
  • Suction method D&C
  • Hysteroscopic myomectomy (removal of submucosal uterine fibroids bulging into uterine cavity)
  • Cesarean section
  • Uterine artery embolization (procedure to block blood flow to uterine fibroids, with the intent to shrink them)
  • Vacuum procedure performed for abortion, this rarely happens
  • IUD (intrauterine device birth control), this rarely happens

Non-surgical procedures that may cause Asherman’s Syndrome:

  • Retained placenta requiring manual removal
  • Uterine packing with gauze to prevent postpartum hemorrhage
  • Douching with a caustic chemical to induce abortion
  • Endometrial tuberculosis
  • Pelvic irradiation for cancer treatment

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