Diagnosis and treatment for intrauterine adhesions
Intrauterine adhesions are a type of scar tissue that forms inside the uterus or cervix, often causing infertility, menstrual issues and pain. Also called Asherman syndrome, this condition may go undiscovered until a woman seeks out help when she is unable to conceive or successfully carry a pregnancy. David T. Vandermolen MD, MS, has the experience and knowledge to diagnose and expertly treat adhesions, helping to resolve symptoms and restore a woman’s ability to get pregnant and stay pregnant.
What are intrauterine adhesions? What causes them?
Intrauterine adhesions are stretchy bands of scar tissue that form inside the uterus, or womb. Because they stretch between and connect the uterine walls, they can make it harder to get pregnant. That’s because having a healthy uterus, with a healthy uterine lining, gives a fertilized egg, or embryo, a safe place to implant and grow.
Even mild adhesions can cause discomfort or menstrual problems. Some women who are able to get pregnant despite adhesions may have pregnancy complications, such as an abnormal attachment of the placenta, and their risk of miscarriage may be higher. In severe cases, the bands of tissue are so thick and strong that they prevent the uterus from expanding like it normally would during pregnancy.
These types of adhesions form when there is damage to the endometrium, or uterine lining. Such damage can be caused by infection or injury, such as surgery to remove fibroids or correct uterine abnormalities, a D&C (dilatation and curettage), miscarriage, or endometrial ablation.
Symptoms of Asherman syndrome
Many women have no symptoms at all, and are unaware that they might have intrauterine adhesions until they have trouble getting pregnant or have repeated miscarriages. For some women, menstrual problems or pain indicate that something isn’t right.
- Very light periods
- Pelvic pain
- Painful periods
- Skipped periods
- Absence of periods
- Infertility
Diagnosing and treating adhesions may restore fertility
Because this condition often causes infertility, it’s important for Dr. Vandermolen to check for intrauterine adhesions and other uterine abnormalities as part of a standard fertility workup. In addition to ultrasound and blood work, Dr. Vandermolen will order a hysterosalpingogram (HSG), a type of imaging study also called a saline infusion sonohysterogram.
For this test, the uterus is filled with a fluid dye, and an X-ray is used to study the outlines of the uterus as well as how the fluid flows within the uterine cavity and fallopian tubes. About 1.5% of women who have an HSG due to infertility are found to have adhesions.
The good news is that if adhesions are identified with an HSG, they can be removed in a minimally invasive procedure called a hysteroscopy. With this procedure, Dr. Vandermolen will insert a thin, lighted scope through the cervix, which will enable him to see the adhesions and remove them using tiny surgical instruments inserted through the cervix.
This procedure is done under general anesthesia, and may involve the temporary placement of a balloon-like device inside the uterus to keep adhesions from re-forming during the healing process. Patients may also be given antibiotics, NSAIDs (non-steroidal anti-inflammatory drugs) and/or estrogen to help prevent regrowth.
Most women with mild to moderate adhesions are able to go on to have successful pregnancies after surgery.
Get help for adhesions
If you are trying to conceive without success, or if you are bothered by troublesome symptoms including pelvic pain or irregular periods, don’t wait to get help. Dr. Vandermolen can expertly diagnose and treat intrauterine adhesions, as well as other causes of infertility and uterine discomfort. Contact us today to schedule a consultation.