The Asherman’s syndrome, or intrauterine adhesions, is a uterine disease characterised by the formation of adhesions (scar tissue) inside de uterus. In many cases the uterus walls get stuck to each other.
In other cases, adhesions only occur in a small portion of the uterus. The extent of the adhesions defines whether the case is mild, moderate, or severe. The adhesions can be thin or thick, spotty in location, or confluent.
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Asherman syndrome occurs when a trauma to the endometrial lining triggers the normal wound-healing process, which causes the damaged areas to fuse together. Most commonly, intrauterine adhesions occur after a dilation and curettage, performed because of a miscarriage. This is due to the fact that, when a dilation and curettage are performed, the uterus may be damaged and, if the wound doesn’t heal properly, it produces scarring on the uterine walls. This scar tissue provokes the front and back walls of the uterus to totally or partially fuse together. The more fused the walls are, the severer the syndrome is.
One of the main characteristics of the Asherman syndrome is that it makes it more difficult to conceive a child and it can be the cause of miscarriages. This is due to the fact that the walls fuse together, avoiding that the formation of the endometrium, and thus making it difficult for the embryo to implant in the uterus. Even though the woman doesn’t have fertility problems, she cannot achieve pregnancy and miscarriages can occur.
There’s a variety of Asherman that is difficult to treat. This variety is known as endometrial sclerosis. This condition may coexist with the formation of adhesions and what happens isn’t that the uterine walls are glued to each other, but the endometrium has been torn out. Even though dilation and curettage may cause it, it’s more common after a uterine surgery such as myomectomy. In these cases, the endometrium, or at least its basal root, has been removed or destroyed.
In order to determine if the woman suffers from this disease,, the gynaecologist must carry out several tests to see if there are adhesions. One of them is transvaginal ultrasonography, and if a positive result is not obtained, a hysterosalpingogram (HSG) will be performed. A hysterosalpingogram is a radiography of the uterus where it can be observed if the uterus walls are fused together.
You must not be alarmed if the results show that you suffer from Asherman syndrome. A surgical internvention is performed to cut the adherences and to separate the walls of the uterus through hysteroscopy, using a small camera to be able to monitor the intervention. Once the problem has been solved and after recovery, the woman shouldn’t have any more problems to achieve pregnancy again and to be able to carry the child to term this time.
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