Asherman’s Syndrome

Overview

Asherman's syndrome is a condition in which bands of scar tissue, called intrauterine adhesions, form inside the uterus and sometimes the cervix. These adhesions can cause the walls of the uterus to stick together, reducing the size of the cavity. The result may be lighter or absent periods, painful periods, repeated pregnancy loss, or difficulty conceiving.

The condition most often develops after a procedure or event that injures the uterine lining, such as a dilation and curettage, uterine surgery, or a severe infection. Treatment focuses on carefully removing the scar tissue and helping the lining heal. This page is an educational overview only, not medical advice, and no outcome can be guaranteed.

Who May Need This

Evaluation and treatment may be considered for women with reduced or absent menstrual periods after a uterine procedure, recurrent miscarriage, infertility, or cyclical pelvic pain that suggests trapped menstrual blood behind adhesions.

Women who have had a D&C (particularly after miscarriage or delivery), uterine surgery such as fibroid removal, or a serious uterine infection are at higher risk. A gynecologist or fertility specialist determines whether adhesions are present and treatment is appropriate.

When It May Be Recommended

Treatment is usually recommended when adhesions are causing symptoms — such as absent periods or pain — or when they are contributing to infertility or pregnancy loss and a woman wishes to conceive. The degree of scarring, from mild to severe, guides the plan.

Very mild, symptom-free adhesions may sometimes be monitored. The decision balances the potential benefits against the risks and the chance of re-scarring, and always depends on individual evaluation.

Diagnosis and Evaluation

Diagnosis often begins with a review of menstrual and surgical history. Imaging may include a pelvic ultrasound, a saline infusion sonogram (ultrasound with fluid in the uterus), or a hysterosalpingogram (an X-ray dye test). The definitive test is hysteroscopy, which lets the doctor see the adhesions directly.

Your specialist may also assess hormones and, when fertility is the goal, evaluate both partners. A clear picture of the extent and location of scarring is important before planning treatment, and a second opinion can be valuable.

Treatment Options

The main treatment is hysteroscopic adhesiolysis — dividing and removing the scar tissue under direct vision. Mild adhesions may separate easily, while dense scarring can require careful, sometimes staged, surgery.

Supporting measures aim to prevent re-scarring and help the lining regenerate. These may include estrogen therapy, placement of a temporary balloon or barrier inside the uterus, and a planned second-look hysteroscopy. Your specialist selects the combination that fits the severity of your condition.

How It Is Performed

Operative hysteroscopy is usually performed under general or regional anaesthesia. The surgeon passes a thin, lighted telescope through the cervix into the uterus and uses fine scissors, or specialised instruments, to carefully cut and remove the adhesions while watching on a monitor, aiming to restore a normal cavity shape.

After the adhesions are divided, the surgeon may insert a small balloon or barrier to keep the walls apart during healing and often prescribes estrogen to help the lining regrow. The procedure is typically day surgery, and difficult cases may need more than one session.

Preparation

Preparation typically includes completing imaging and any hormone or fertility tests, reviewing medications with your doctor, and fasting before anaesthesia. Your specialist may time the surgery to your menstrual cycle and start hormone therapy as part of the plan.

If you are travelling for treatment, plan for the in-country stay your team advises, allow for a possible second-look procedure, and bring your imaging and gynecological records so the treating team has your full history.

Benefits and Expected Goals

The goals are to restore a normal uterine cavity, improve or return menstrual periods, relieve pain, and, for those trying to conceive, improve the chances of pregnancy. Many appropriately selected women see meaningful improvement.

Benefits vary greatly with the severity of the scarring and other individual factors, and adhesions can re-form. Treatment can improve but cannot guarantee restored fertility or a successful pregnancy. Your specialist can discuss realistic goals for your case.

Risks and Possible Complications

As with any uterine surgery, there are risks.

• Re-formation of adhesions, especially with severe scarring
• Bleeding or infection
• Perforation (a hole) of the uterine wall during hysteroscopy
• Fluid absorption during the procedure
• Pregnancy-related risks later, such as abnormal placental attachment, requiring careful monitoring

Your surgeon will explain the risks specific to your situation. Report heavy bleeding, fever, or severe pain promptly.

Recovery, Follow-up & Aftercare

Recovery from hysteroscopy is usually quick, with light bleeding and mild cramping for a few days. If a balloon or barrier was placed, it is removed after a short period as directed. Estrogen therapy, when prescribed, is taken to encourage the lining to heal.

A follow-up hysteroscopy is often planned to confirm the cavity has healed and to treat any early re-scarring. If you are trying to conceive, your specialist will advise on timing. Arrange follow-up with your local doctor before travelling home.

Medical Tourism Planning

If you are considering treatment abroad, choose a JCI- or ISO-accredited hospital with a strong hysteroscopy and fertility service, since experience matters greatly for this delicate surgery. Verify the specialist's experience with intrauterine adhesions and request a written treatment plan and cost estimate.

Because a second-look procedure may be needed, plan your stay and follow-up carefully, and arrange continuing care with your gynecologist or fertility doctor at home. Consider medical travel insurance.

Estimated Cost Factors

Cost depends on the country and hospital, the surgeon's fees, the severity of scarring and number of procedures needed, anaesthesia, any barrier devices or hormone therapy, and follow-up hysteroscopy.

Many destinations offer this treatment at a fraction of typical US prices, but figures vary widely by case. Online prices are only estimates — always request a personalized written quote for your specific situation before deciding.

Choosing a Hospital or Specialist

Look for a hospital with recognised accreditation and a specialist experienced in complex hysteroscopic surgery and reproductive care. Ask about their experience with severe adhesions and their strategy for preventing re-scarring.

Ask about international patient services, interpreter support, and how follow-up and any second procedure would be handled. Transparent written cost and treatment plans are good signs of a quality programme.

Alternatives

For women not seeking pregnancy and with few symptoms, monitoring may be reasonable. When fertility is the goal but the uterus cannot be adequately restored, options such as gestational surrogacy or adoption may be discussed. Hormone therapy may help symptoms in some cases.

Each option has different benefits and limitations. Discuss all of them with your healthcare provider so the plan fits your goals and the severity of your condition.

Questions to Ask Your Doctor

• How severe is my scarring, and how might it affect my periods and fertility?
• How many hysteroscopic procedures might I need?
• What will you do to reduce the chance of adhesions re-forming?
• What are realistic expectations for my periods and for pregnancy?
• What are the specific risks in my case, including in a future pregnancy?
• How long should I stay in-country, and what follow-up will I need?
• What is included in the written cost estimate?