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Asherman's syndrome, also known as AS, is a term describing scar tissue in the uterus that affects a woman's menstrual cycle and fertility. This rare condition is usually the result of surgeries or infections and presents with a multitude of symptoms resulting from inflammation of the uterine lining. Asherman's syndrome is treated with surgery; while mild cases are often easily cured, moderate to severe cases may need ongoing monitoring and treatment.
AS is most often caused by several dilation and curettage (D&C) procedures. The scraping of the uterus with a curette, when done a number of times, can leave behind scar tissue and cause intrauterine adhesions. It is estimated that nearly 8% of women who have had more than one D&C will develop this health issue. Asherman's syndrome can also be caused by pelvic infections, tuberculosis, and schistosomiasis, a parasitic infection. These diseases can cause inflammation of the female reproductive organs, thus potentially resulting in scar tissue.
The most common symptoms of Asherman's syndrome are repeated miscarriages, excessive uterine cramping, and the lack of a menstrual period. AS often leads to infertility. These symptoms are caused by the reduced space in the uterus as it becomes crowded with scar tissue. This leaves little space for an egg to implant in the lining; both menstrual periods and pregnancy are the result of implantation of an egg.
Asherman's syndrome is diagnosed by a vaginal ultrasound, the same type of ultrasound used in the early stages of pregnancy. For a closer look at the uterine lining, a hysterosonogram, similar to a vaginal ultrasound, or a hysteroscopy may be performed to determine the exact location and severity of the intrauterine adhesions. In conjunction with these diagnostic tools, blood testing is often done to rule out any other possible issues.
AS is treated with a surgical procedure to remove the scar tissue from the uterus. Due to the delicacy of the surgery, most cases of Asherman's syndrome are best treated by surgeons specializing in the condition. Following the surgery, a balloon is placed inside the uterus for up to two weeks. This helps to prevent any new scar tissue from forming as a result of the surgery. While Asherman's syndrome surgery is often successful, many women will need several procedures because intrauterine adhesions often regrow after the surgery.
In some cases, treatment of Asherman's syndrome can resolve a woman's fertility issues, allowing her to carry a baby to term. In moderate to severe cases of AS and in cases where repeated surgeries are needed, carrying a child may not be a possibility. With each surgery, more of the lining of the uterus is removed, and there comes a point when the lining is too thin to support a growing fetus.
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