ASHERMAN’S SYNDROME AND ADHESIONS

Adhesions in the uterus or a blockage in the endometrial cavity are a challenge for women who wish to gestate but who are not achieving their goal

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What is Asherman’s Syndrome and what are uterine adhesions?

Uterine adhesions are defined as pathological adhesions (unions) in the uterine walls. They are generally caused by gynaecological procedures in the uterus such as curettage, hysteroscopic myomectomies and so on. Hysteroscopies play an essential role in their diagnosis.

Asherman’s Syndrome is defined as the link between uterine adhesions and one or several of the symptoms associated with the syndrome such as a limited or absent menstruation.

What are the symptoms of Asherman’s Syndrome?

The most common symptoms include:

Abnormalities. Changes to the menstrual cycle including very light periods (hypomenorrhoea) and/or a total absence of periods (amenhorroea).
Infertility. Infertility can be caused by:
- Spermatozoa that have difficulties reaching the Fallopian tubes or the uterine cavity because adhesions are blocking their path.
- Abnormalities on the inside of the uterus that complicate embryo implantation.
Obstetrical complications during pregnancy. Specifically, abnormalities in placenta formation during embryo development (placentation) or recurrent pregnancy losses.

How is Asherman’s Syndrome diagnosed?

The principal means of diagnosis is with a hysteroscopy since it allows us to perform a direct, visual diagnosis and determine where the disease is located, how serious it is and how to classify it. It also means that it is possible to assess the endometrium and determine which type of surgery is the most suitable for treating the condition.

There are many different ways of classifying uterine adhesions and the ones that are used most commonly are those developed by the American Fertility Society (AFS) and the European Society for Gynaecological Endoscopy (ESGE).

A presence of uterine adhesions in a women is linked to:

Recurrent curettage.
Hysteroscopic removal of uterine fibroids. The risk is greater when we perform a resection of more than one fibroid or when fibroids are opposed.
Other surgical hysteroscopy techniques such as polypectomies or resections performed on septums can also cause adhesions.
With regards to fibroid embolisation, treatment is linked to elevated adhesion rates and, as such, this procedure should never be performed on women who wish to get pregnant.

How can Asherman’s Syndrome be treated and what is the prognosis?

The treatment for this syndrome is a hysteroscopy, mainly using diagnostic hysteroscopies since no preparatory cervical dilation is needed because, in the case of adhesions, this can increase the risk of perforating the uterus. The use of hyaluronic acid anti-adhesion barrier gels are now recommended following a hysteroscopy since they have been proven to reduce relapse rates.

Treatment based on the type of adhesion:

Slight adhesions can easily be removed with the combined effect of liquid distension and a hysteroscopy. In the case of slight adhesions, we need to use scissors or bipolar minielectrodes. The result should be a normal uterine cavity in which the areas around the Fallopian tube orifices are visible on the same plane.
Complex cases of uterine adhesions call for the intervention of a specialist gynaecological surgeon because they pose a greater risk of complications as well as an elevated risk of failure and relapse. It should be pointed out that it sometimes takes several attempts to resolve the issue.

In terms of prognosis following treatment, it is estimated that an elevated percentage of patients begin menstruating once again.

Relapse rates during control hysteroscopies are also high and, as such, all guides recommend performing a diagnostic hysteroscopy or posterior checks following treatment.

In terms of fertility, a significant percentage of patients recuperate their ability to reproduce although this also depends on factors such as age, the severity of the adhesions and what caused them. The worst prognoses are for cases following fibroid embolisation, relapses in control hysteroscopies or regulation of the menstrual cycle following surgery.

Pregnancies following treatment for Asherman’s Syndrome have a very high risk of abnormalities in the placenta (placenta formation) as well as an elevated risk of postpartum haemorrhages.

Comprehensive treatment at Instituto Bernabeu

Since this is a complex pathology, getting the uterine cavity back to normal usually takes more than one diagnostic or therapeutic hysteroscopy. The number of necessary hysteroscopies can vary depending on the severity of the case and the severity of the uterine adhesions.

Instituto Bernabeu has avant-garde hysteroscopy equipment and a team of gynaecologists who have received specific training for treating patients with uterine adhesions and Asherman’s Syndrome. Experience and the doctor’s personal ability, in particular, play an important role in reversing and monitoring this pathology.

Our aim is to correct adhesions without generating any additional financial stress. As such, we offer the option of a comprehensive treatment pack including any necessary hysteroscopies performed under anaesthetic and anti-adherence gels in order to decrease the risk of a relapse. Versapoint® technology is used when necessary. Request further information.