Asherman Foundation

Ever heard of intrauterine adhesions? Probably not the first go-to topic for a chit-chat, but they’re very real—and if you’re dealing with them, you’re definitely not alone. Lots of women suffer from adhesions, but since they´re not always diagnosed, we´re not always aware of having them.

So whether you’re here wondering if adhesions are causing some of your symptoms, are looking for help or just want to learn more about this medical condition, here’s everything you should know about Asherman Syndrome.

What is Asherman Syndrome?

Having Asherman Syndrome means you´re overdeveloping scar tissue (the so-called adhesions) inside your uterus. Depending on where and how severe they are, they can limit the uterus space and block your cervix. This can lead to abnormal menstruation, pelvic pain and can sometimes makes it hard to conceive.

Causes

Asherman Syndrome is usually diagnosed as a consequence of uterine trauma. However, some people simply seem to be more prone to developing adhesions. Research shows that a different balance in cell types and how they interact can lead to a pro-inflammatory environment in the endometrium, affecting how your body responds.

That said, the most common and direct causes of the initial uterine trauma leading to adhesions include:

• Curettage or dilation: often done after a miscarriage, abortion, or delivery. Mostly when the procedure was incomplete and the uterus wasn’t entirely cleared.
• Surgical interventions: surgeries like a myomectomy or cesarean section
• Infections: Severe uterine infections, such as endometritis
• Certain cancer treatments

While these are the most common causes, only a few percentage of people who undergo these procedures actually develop Asherman Syndrome. As mentioned above, individual health, genetic factors and surgical techniques also influence the appearance.

Besides the above, uterine adhesions have occasionally been found in individuals who´ve had treatments in closely located organs such as the bladder or intestine.

How common is Asherman Syndrome?

It’s hard to know exactly how common Asherman Syndrome is because mild cases often go undiagnosed. It´s currently considered a rare syndrome since it´s only been diagnosed in 1 out of 10.000 women—meaning it might not be the first thing your doctor thinks of when assessing your symptoms. Adhesions are still being studied, and unfortunately, many healthcare professionals don’t have a deep understanding of them yet.

Even though adhesions are considered rare, we want to help you get the answers you deserve. By sharing everything we know, you’ll be able to bring this possibility up with your doctor and get diagnosed.

Main symptoms of intrauterine adhesions

Symptoms of Asherman Syndrome can vary depending on how severe and where the adhesions are. Common signs include:

• Changes in menstrual flow: your periods might become lighter, irregular, or stop altogether (amenorrhea). Sometimes your menstruation will stop and continue a few days later. Your blood flow might have a different consistency than before. It can include spotting, blood clotting or thick scar tissue.
• Pelvic pain or discomfort: chronic pelvic pain or cramping can occur, mostly prior to- or during your period. You might feel symptoms of inflammation and feel like your menstruation should have come out for days already but it´s not actually appearing.
• Difficulty getting pregnant: adhesions can interfere with the uterine lining or entrance, making it harder to conceive.
• Recurrent miscarriages: some people suffer from repeated pregnancy losses.

Diagnosis

A good first step to diagnose the existence of adhesions is to talk to your gynaecologist about your medical history—especially any past uterine procedures, infections, or surgeries as these can be key indicators. If your doctor suspects adhesions to be the cause, they will most likely recommend the following diagnostic steps:

Hysteroscopy: a thin, flexible camera is inserted into your uterus through the cervix, allowing your doctor to directly see (and potentially remove) any scar tissue. It’s not always mentioned, but you have a choice—you can stay awake or opt for sedation, whatever feels right and most comfortable for you.
Sonohysterogram: a specialized ultrasound in which a saline solution is injected into the uterus to create a clearer image of its shape and any possible adhesions.
Ultrasound: uses sound waves to create images of the uterus, might sometimes suggest the presence of adhesions but is generally less reliable. A routine uterus scan typically won’t detect them.

Treatments

Asherman treatments usually focus on removing scar tissue, restoring the uterus to normal and preventing adhesions from growing back. Here are some of the options that specialists tend to apply. Keep in mind that your treatment will depend on your personal situation, severity of the adhesions and medical background.

• Removing the scar tissue: this can be done in the same procedure as your diagnostic hysteroscopy. Through a thin, flexible camera, a specialist can both see and remove any scar tissue.
  
• Preventing returning adhesions: your specialist might place an IUD, balloon or apply gel to prevent adhesions from forming again after the above mentioned surgical hysteroscopy. These usually get removed after a couple of weeks, during your final evaluation hysteroscopy, where your specialist can see if the treatment has worked and adhesions have not grown back
  
• Hormonal therapy: additionally, estrogen hormone therapy can help strengthen the uterine lining after the adhesions are removed. Your healthcare provider might advise you to take hormone supplements for a couple of months, depending on your personal situation.
  
• Stem cell therapy: this new, upcoming treatment can be applied to patients that suffer from recurring adhesions. By implanting specific cell types obtained from your own blood, stem cell therapy helps you strengthen your uterus health on a deeper level. The improved harmony and communication between cells can avoid formation of new adhesions and boost fertility. Since this is a very new treatment yet to be rolled out, not many clinics in 2025 will offer this just yet.
  
• Follow-up hysteroscopy: Finally, your doctor will schedule a hysteroscopy to see if the treatment has worked and the adhesions haven’t grown back.

Recovery

Asherman Syndrome recovery varies a lot. After removing adhesions, there´s usually a 50% chance you´ll stay clean. In case they do return, you´ll need a follow up treatment. For some women, dealing with Asherman can be a hopeless and stressful experience. For others, it´s a one off.

Asherman recovery can be tough, not just physically but emotionally too. The mix of hormonal changes, physical exhaustion and uncertainty can feel overwhelming. Will the adhesions come back? Am I healing the way I should? Can I still get pregnant—and when? These are real concerns that many go through. It’s not easy, but please remember—you’re not alone in this.

How to get help

Treating Asherman syndrome requires expertise, precision and personal attention. Especially since the adhesions could return, you want to make sure you get treated by the best specialists only. Therefore it’s important to find a clinic that understands the syndrome, has the latest technology in place and carefully listens to your needs and past treatments. 

• Gynecologists: For diagnosing and managing the condition.
• Reproductive endocrinologists: Especially for those trying to conceive.
• Hysteroscopy specialists: Experts in the procedure to remove adhesions.
• Psychologists:
• Support communities

Some hospitals, like Spaarne Hospital, offer comprehensive care with a range of experts to address both the physical and emotional aspects of the condition.