Summary about Disease
Uterine adhesions, also known as Asherman's Syndrome, are scar tissue formations inside the uterus. These adhesions can cause a range of problems, from menstrual irregularities to infertility. The severity of the condition varies depending on the extent and location of the adhesions. In mild cases, adhesions may be thin and sparse, while in severe cases, the entire uterine cavity may be scarred and obliterated.
Symptoms
The most common symptoms of uterine adhesions include:
Absent or scant menstrual periods (amenorrhea or hypomenorrhea): This is a hallmark symptom.
Pain: Some women experience pelvic pain, especially during ovulation or around the time their period would normally occur.
Infertility: Adhesions can block the implantation of a fertilized egg or interfere with normal uterine function, leading to difficulty conceiving.
Recurrent miscarriage: Adhesions can disrupt pregnancy and increase the risk of miscarriage.
Abdominal pain: Some patients experience abdominal pain
Causes
The primary cause of uterine adhesions is trauma to the uterine lining, usually related to:
Dilation and curettage (D&C): This procedure, often performed after miscarriage, childbirth, or elective abortion, is the most common cause.
Hysteroscopic surgery: Surgery within the uterus, particularly if it involves removing fibroids or polyps, can sometimes lead to adhesions.
Uterine infection: Pelvic inflammatory disease (PID) or other uterine infections can, in rare cases, cause adhesions.
Cesarean section: Less common but possible.
Medicine Used
There is no medicine to directly remove or dissolve uterine adhesions. Treatment primarily involves surgical removal of the adhesions via hysteroscopy.
Hysteroscopy: Surgical removal of adhesions.
Hormone therapy (Estrogen): Estrogen is often prescribed after surgery to promote endometrial healing and prevent reformation of adhesions.
Antibiotics: Prescribed if an infection is suspected or present.
Intrauterine Device (IUD): An IUD may be placed in the uterus after surgery to help keep the uterine walls separated during the healing process.
Is Communicable
Uterine adhesions are NOT communicable or contagious. They are not caused by an infectious agent that can be spread from person to person.
Precautions
Precautions to potentially reduce the risk of uterine adhesions include:
Careful consideration of D&C: Discuss alternative options with your doctor whenever possible. If a D&C is necessary, ensure it is performed carefully and by an experienced provider.
Minimally invasive surgical techniques: If hysteroscopic surgery is needed, choose a surgeon skilled in minimally invasive techniques.
Prompt treatment of uterine infections: Seek prompt medical attention for any symptoms of pelvic inflammatory disease or other uterine infections.
Post-surgical follow-up: Adhere to all post-operative instructions and attend all follow-up appointments after any uterine surgery.
How long does an outbreak last?
Uterine adhesions are not an "outbreak." They are a chronic condition resulting from damage to the uterine lining. Once adhesions form, they will persist until surgically removed. The effects of the adhesions (e.g., menstrual irregularities, infertility) will last until the adhesions are treated.
How is it diagnosed?
Diagnosis of uterine adhesions typically involves:
Medical history and physical exam: Reviewing your symptoms and medical history.
Hysterosalpingogram (HSG): An X-ray test that uses dye to visualize the uterus and fallopian tubes. This can reveal the presence and extent of adhesions.
Hysteroscopy: A procedure where a thin, lighted scope is inserted into the uterus to directly visualize the uterine cavity. This is the most accurate diagnostic method.
Sonohysterogram (Saline Infusion Sonography): Ultrasound after saline is injected into the uterus to better visualize the uterine lining.
MRI: In some cases, an MRI may be used to assess the uterus and surrounding tissues.
Timeline of Symptoms
The timeline of symptoms can vary, but typically:
Following uterine trauma (e.g., D&C): Symptoms may appear shortly after the procedure, within the next menstrual cycle or two.
Gradual onset: In some cases, symptoms may develop gradually over time.
Early signs: Scant or absent periods may be the first indication.
Infertility: Difficulty conceiving may become apparent after several months of trying.
Important Considerations
Early diagnosis and treatment are crucial: The sooner adhesions are diagnosed and treated, the better the chances of restoring normal uterine function and fertility.
Recurrence is possible: Even after surgical removal, adhesions can sometimes reform. Follow-up care and hormone therapy can help prevent recurrence.
Multiple surgeries may be necessary: In severe cases, multiple hysteroscopic surgeries may be required to completely remove the adhesions.
Seek a specialist: Choose a gynecologist with experience in diagnosing and treating uterine adhesions. Reproductive endocrinologists are often the most qualified to manage this condition, particularly if fertility is a concern.