By Dr José Manuel Gómez Santana (Gynecologist – License No. 030309086).
It is not one of the most well-known gynecological problems, but it is increasingly becoming a concern in women’s reproductive health. Asherman’s syndrome is a uterine condition that can cause a partial or total reduction of the uterine cavity, which may lead to difficulties in achieving pregnancy.
Although it is a rare disorder, awareness of its existence is crucial for early diagnosis and appropriate management. Detecting it in time not only improves the chances of pregnancy but also helps preserve uterine health over the long term.
The condition is named after gynecologist Josef Asherman, who first described it in 1948. It is primarily characterized by the presence of adhesions or scar tissue within the uterine cavity, which causes a partial or total reduction of the uterine space. The issue with this condition is that it often goes unnoticed for years and is only discovered when a woman tries to conceive and encounters difficulties doing so.
Among the most common causes of Asherman’s syndrome are:
These procedures can damage or destroy the basal layer of the endometrium, promoting the formation of intrauterine adhesions. These adhesions—also known as synechiae—can alter the uterine cavity, hinder embryo implantation, and cause menstrual or fertility problems.
As mentioned before, many women live with this syndrome without being aware of it, since its symptoms are not always noticeable or alarming, which reduces medical follow-up and care.
The most common symptoms include decreased or absent menstrual bleeding—known as hypomenorrhea or secondary amenorrhea—or recurrent pelvic pain. However, in many women, the syndrome does not produce any obvious signs and is only detected during fertility assessments due to difficulty conceiving.
Diagnosis of Asherman’s syndrome requires a hysteroscopy—a procedure that allows direct visualization of the uterine cavity to assess the extent of the adhesions.
Treatment focuses on removing the adhesions that form within the uterus to restore normal endometrial function. This improves both menstruation and fertility. The procedure is typically performed through hysteroscopic surgery, which is considered the treatment of choice. Additionally, after surgery, special intrauterine devices (IUDs) or small Foley catheters may be placed to keep the uterine walls separated during healing. Estrogens are usually administered, followed by progestogens, to stimulate endometrial regeneration and promote proper healing.
Many women diagnosed with this condition wish to become pregnant, but whether this is possible depends on the degree of severity. In mild cases, restoration of the uterine cavity can allow fertility to return and successful pregnancies to occur. However, when adhesions are more severe, the probability of conception decreases, and assisted reproductive techniques may be necessary.
Each patient’s condition must be carefully evaluated, but the truth is that thanks to medical advances, more and more women with Asherman’s syndrome are achieving pregnancy. Although it is a rare disorder, raising awareness about it remains essential for early diagnosis and appropriate management. Detecting it in time not only improves the chances of conception but also contributes to preserving uterine health in the long term.
AAGL Elevating Gynecologic Surgery.
AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE).
.
2017;
6
Documento sobre el diagnóstico, clasificación, prevención y tratamiento de las adherencias intrauterinas, incluido el síndrome de Asherman, con especial atención al papel de la histeroscopia:
https://doi.org/10.1186/s10397-017-1007-3
Di Guardo F, Della Corte L, Vilos GA, Carugno J, Török P, Giampaolino P, Manchanda R, Vitale SG.
Evaluation and treatment of infertile women with Asherman syndrome: an updated review focusing on the role of hysteroscopy.
.
2020;
55-61
Revisión actualizada sobre la evaluación y el tratamiento del síndrome de Asherman en mujeres con infertilidad, centrada especialmente en el papel diagnóstico y terapéutico de la histeroscopia:
https://doi.org/10.1016/j.rbmo.2020.03.021
Guo EJ, Chung JPW, Poon LCY, Li TC.
Reproductive outcomes after surgical treatment of asherman syndrome: A systematic review.
.
2019;
98-114
Revisión sistemática de los resultados reproductivos después de la adhesiolisis histeroscópica en mujeres con síndrome de Asherman, incluyendo embarazo, pérdida gestacional y complicaciones obstétricas:
https://doi.org/10.1016/j.bpobgyn.2018.12.009
Hooker AB, de Leeuw RA, Emanuel MH, Mijatovic V, Brolmann HAM, Huirne JAF.
The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature.
.
2022;
837
Revisión sistemática sobre la relación entre las adherencias intrauterinas y la alteración de la función reproductiva, incluyendo infertilidad, implantación y complicaciones durante el embarazo:
https://doi.org/10.1186/s12884-022-05164-2
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