Uterine Synechiae (Asherman Syndrome)

What it is

Uterine synechiae are adhesions that form inside the uterine cavity, joining the walls together and reducing the space where the endometrium develops. When they cause symptoms, the condition is called Asherman syndrome. They most often arise after a D&C for miscarriage or after childbirth, uterine surgeries, and infections, which damage the deepest layer of the endometrium. The consequences range from light or absent periods to cyclic pain, difficulty conceiving, and repeated pregnancy loss. The gynecology team at Femi Saúde diagnoses synechiae with ultrasound and hysteroscopy and performs hysteroscopic adhesiolysis, with follow-up to prevent recurrence.

Most common symptoms

• Very light or absent periods after a D&C
• Cyclic cramping without bleeding
• Persistent difficulty conceiving
• Recurrent miscarriage
• Placental problems in previous pregnancies
• No symptoms, found incidentally on examination

Causes and risk factors

• D&C after miscarriage or after childbirth
• Removal of fibroids or polyps with endometrial injury
• Uterine infections, such as endometritis
• C-section and other uterine surgeries
• Genital tuberculosis, more rarely

How it is diagnosed

Suspicion arises when periods decrease or disappear after a D&C or uterine surgery, or in the setting of infertility and pregnancy loss. Transvaginal ultrasound may show a thin or irregular endometrium and areas of cavity interruption. Saline-infusion sonohysterography, with fluid inside the uterus, and hysterosalpingography reveal filling defects. Diagnostic hysteroscopy is the definitive test: it allows direct visualization of the adhesions, classification of their extent and thickness, and an assessment of how much healthy endometrium remains, information that guides treatment and prognosis.

How we treat it at Femi Saúde

Treatment is adhesiolysis by surgical hysteroscopy, in which the adhesions are cut under direct visualization, with delicate instruments, to restore the shape of the cavity. After the procedure, the gynecology team at Femi Saúde takes steps to keep the walls from reuniting, such as estrogen for a few weeks to stimulate endometrial growth and, in selected cases, a temporary intrauterine balloon or IUD. A follow-up hysteroscopy confirms the result and treats any residual adhesions. Extensive cases may require more than one procedure. Women who wish to conceive receive individualized guidance on when to try and on monitoring during pregnancy.

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