Asherman Syndrome Definition, Reason, Symptoms, Treatment & Prevention
Definition
Asherman’s syndrome is a condition of uterine disorders characterized by scar tissue and adhesions on the inside of the uterus. This condition occurs as a result of an injury or trauma that has occurred in the uterus, for example due to curettage.
Asherman’s syndrome is a very rare condition.
Asherman Syndrome Symptoms
Asherman’s syndrome doesn’t always have symptoms. If the scar tissue in the uterus is only in certain narrow locations and adhesions in the uterus also do not occur in many places, then there are usually no symptoms. However, if the scar tissue or adhesions that occur in the uterus are large enough, symptoms may arise.
The most common symptom is menstrual disorders. People with Asherman’s syndrome can experience infrequent menstruation, even no menstruation at all. Sometimes sufferers complain of lower abdominal pain or pre-menstrual symptoms such as aches in the waist or back, but no menstrual blood comes out at all.
Actually, in these circumstances, menstruation still occurs. However, menstrual blood cannot come out of the uterus because it is blocked by scar tissue and adhesions.
In addition, sufferers of Asherman’s syndrome can also have difficulty getting pregnant. This happens because it is difficult for the sperm to meet the egg in the uterus if the adhesions in the uterus are too great.
Not infrequently, sufferers of Asherman’s syndrome can also get pregnant but complications occur in pregnancy such as:
- Miscarriage or fetal death in the womb
- Placenta previa, which is a condition where the placenta is abnormally located which is characterized by the placenta covering the birth canal.
- Placenta accreta, namely the condition of the placenta that is attached too deep to the uterine muscle.
- Heavy bleeding during pregnancy
Asherman Syndrome Reason
Most cases of Asherman’s Syndrome (about 90 percent) occur after a dilation and curettage procedure. This action is an action that is commonly performed in conditions of incomplete abortion (miscarriage with some of the fetus remaining or the placenta still in the uterus), retained placenta (placenta that does not want to separate from the uterus during delivery), or abortion that must be carried out due to medical considerations.
In addition, Asherman’s syndrome can also occur due to surgery in the pelvic area, such as a Caesarean section, surgical removal of polyps, or surgical removal of myomas.
Diagnosis
In the early stages, the doctor will conduct a thorough interview regarding the complaints you are experiencing. The doctor will ask about a history of miscarriage, as well as a history of curettage or surgery in the uterine area. Apart from that, the doctor will also ask about her menstrual cycle over the past few months.
After that, there are several checks that will generally be carried out, such as:
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Ultrasonography (USG)
An ultrasound exam cannot see the adhesions or scar tissue in the uterus that occurs in Asherman’s syndrome. However, this examination is a basic examination carried out to rule out other possible diagnoses that have symptoms similar to Asherman’s syndrome.
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hysteroscopy
Hysteroscopy is a type of examination like an endoscope which is carried out by inserting a small camera from the vagina into the uterus. Through this examination, the inside of the uterus will be seen clearly, including if there are adhesions and scar tissue as occurs in Asherman’s syndrome.
Asherman Syndrome Treatment
The scar tissue and adhesions that occur in Asherman’s syndrome generally cannot be removed completely. However, that does not mean Asherman’s syndrome can not be treated.
Patients with Asherman’s syndrome need to receive treatment if they want to plan a pregnancy or feel very disturbing complaints due to this disease, for example, severe lower abdominal pain. Conversely, if you don’t want to have children and there are no disturbing complaints, there is no need for treatment.
Treatments that can be done to reduce adhesions and scar tissue in Asherman’s syndrome include:
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hysteroscopy
Hysteroscopy is not only an action to confirm the diagnosis, but during a hysteroscopy, the doctor can also use instruments to cut and remove adhesions in the uterus.
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Hormonal treatment
Treatment with the hormone estrogen is generally given to improve tissue growth in the uterus.
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Antibiotics
Antibiotics will also be given to prevent infection in the uterus. This is important to prevent the adhesions in the uterus from getting worse.
Prevention
Asherman’s syndrome will not occur if a person has never had a uterine procedure such as surgery or curettage. But sometimes curettage or surgery on the uterus cannot be avoided.
To reduce the risk of Asherman’s syndrome due to curettage, doctors generally perform curettage guided by ultrasound to minimize injury to the inner wall of the uterus.