Summary about Disease
Intrauterine adhesions (IUAs), also known as Asherman's Syndrome, is a condition characterized by the formation of scar tissue within the uterine cavity. These adhesions can range from thin, filmy bands to thick, dense scars that partially or completely obliterate the uterine cavity. IUAs can lead to a variety of reproductive problems, including infertility, recurrent pregnancy loss, and menstrual irregularities.
Symptoms
Menstrual Changes: This is the most common symptom. It can manifest as:
Hypomenorrhea (scanty periods)
Oligomenorrhea (infrequent periods)
Amenorrhea (absence of periods)
Infertility: Difficulty conceiving.
Recurrent Pregnancy Loss: Repeated miscarriages.
Pelvic Pain: In some cases, particularly when menstrual flow is blocked.
Painful Periods (Dysmenorrhea): Though less common, adhesions can sometimes contribute to painful menstruation.
Causes
The most common cause is uterine instrumentation following a pregnancy-related event, such as:
Dilation and Curettage (D&C): Especially after a miscarriage, delivery, or termination of pregnancy. The risk is higher when D&C is performed during the postpartum period or in the presence of infection.
Hysteroscopic Surgery: Procedures like myomectomy (fibroid removal) or polypectomy (polyp removal) can sometimes lead to adhesion formation.
Infections: Pelvic infections, particularly endometritis (infection of the uterine lining), can contribute.
Other Uterine Surgeries: Rarely, other uterine surgeries may lead to adhesions.
Other Rare causes: Uterine artery embolization, tuberculosis, or other infections.
Medicine Used
There is no medicine to directly remove intrauterine adhesions. However, medications are used adjuntively:
Estrogen: Commonly prescribed after surgical removal of adhesions to promote uterine lining (endometrium) growth and prevent reformation of adhesions. Given orally or vaginally.
Progestins: May be used in combination with estrogen to regulate the menstrual cycle after adhesion removal.
Antibiotics: Prescribed to treat any underlying infection that may be contributing to adhesion formation.
Pain relievers: Over-the-counter or prescription pain relievers may be used to manage any pelvic pain.
Is Communicable
No, Intrauterine Adhesions are not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Careful Uterine Procedures: Surgeons should use meticulous technique during D&C and hysteroscopic procedures to minimize trauma to the uterine lining.
Prompt Treatment of Infections: Treat pelvic infections, particularly endometritis, promptly and effectively.
Consider Medical Management: In some cases, medical management of miscarriage (using medication instead of D&C) may reduce the risk of IUAs.
Post-Surgical Management: Estrogen therapy is used after surgical removal of adhesions to promote endometrial healing. Placement of a balloon catheter or other device within the uterus can help keep the walls separated during healing and prevent adhesion reformation.
Follow-up: Regular follow-up with a gynecologist after uterine procedures can help detect and address any potential problems early.
How long does an outbreak last?
Intrauterine adhesions do not have outbreaks. They are a structural problem within the uterus. The symptoms associated with IUAs persist until the adhesions are treated, usually surgically. Without treatment, the symptoms (e.g., menstrual irregularities, infertility) will continue.
How is it diagnosed?
Hysterosalpingogram (HSG): An X-ray procedure where dye is injected into the uterus and fallopian tubes. It can reveal the presence and extent of adhesions.
Hysteroscopy: A direct visual examination of the uterine cavity using a thin, lighted scope inserted through the cervix. This is the gold standard for diagnosing and treating IUAs, allowing for direct visualization of the adhesions.
Sonohysterography: Involves the use of ultrasound to visualize the uterine cavity after instilling saline.
Timeline of Symptoms
The timeline of symptoms can vary depending on the extent and severity of the adhesions, and the underlying cause.
Shortly after Uterine Trauma (e.g., D&C): Menstrual changes (hypomenorrhea, amenorrhea) are often the first sign.
Within Months: If conception is attempted, infertility may become apparent.
Ongoing: Recurrent pregnancy loss may occur.
Varies: Pelvic pain may be present immediately or develop over time.
Important Considerations
Early Diagnosis and Treatment: Early detection and treatment are crucial for improving outcomes and preserving fertility.
Recurrence: Adhesions can recur after treatment, so close monitoring and follow-up are important. Repeat hysteroscopies may be needed.
Fertility Potential: While IUAs can significantly impact fertility, treatment can often improve the chances of conception and successful pregnancy.
Severity: The extent and density of the adhesions directly correlate with the severity of symptoms and the difficulty of treatment. Mild adhesions are easier to treat with a better prognosis, while severe adhesions have a poorer prognosis.
Expertise: Seeking care from a reproductive endocrinologist or gynecologist with experience in treating IUAs is important for optimal management.