Pregnancy Loss Pregnancy Loss Causes and Risk Factors Asherman's Syndrome and Miscarriage By Krissi Danielsson Krissi Danielsson Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. Learn about our editorial process Updated on November 14, 2019 Medically reviewed by Brian Levine, MD, MS, FACOG Medically reviewed by Brian Levine, MD, MS, FACOG Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019. Learn about our Medical Review Board Print Ian Hooton/Science Photo Library/Getty Images Asherman's syndrome, characterized by scarring in the uterus, is a condition most often associated with a common surgical procedure called dilation and curettage (D&C). The D&C may be used to remove excess tissue for any number of reasons, including: To resolve abnormal uterine bleedingTo sample an abnormally thick lining as can happen in women with PCOS, endometrial hyperplasia, or endometrial cancerTo remove tissue not totally expelled after a missed miscarriage, incomplete miscarriage, or deliveryTo terminate a pregnancy or remove tissue not totally expelled after a missed miscarriage, incomplete miscarriage, or delivery Following a D&C, uterine tissues can sometimes stick together abnormally and form adhesions. Fibrosis, the thickening, and scarring of connective tissue are also involved. Depending on the extent and severity of the scarring, Asherman's syndrome may result in miscarriage, infertility, pain caused by trapped blood, and other obstetric complications. While a D&C is the predominant cause of Asherman's syndrome, other conditions can lead to uterine scarring, including pelvic radiation and the use of intrauterine devices (IUDs). Symptoms Asherman's syndrome often causes no symptoms aside from a difficulty in conceiving or maintaining a pregnancy. The formation of adhesions and fibrosis typically reduces blood flow to the uterus. When this happens, some women may have extremely light periods or have no periods (amenorrhea). If blockages develop, they can often cause pain during ovulation or menstruation. Diagnosis The gold standard for diagnosing Asherman's syndrome is a procedure called a hysteroscopy in which a thin, lighted scope is inserted into the vagina to examine the cervix and uterus. Doctors may also order X-rays, transvaginal ultrasound, and biopsy to evaluate the severity and extent of scarring and to help determine the course of treatment. Risk Factors and Outcomes The risk of Asherman's syndrome is often associated with the number of D&C procedures a woman undergoes. Treatments The surgical removal of adhesions can significantly improve the odds of having a successful pregnancy. With that being said, it can be a technically difficult procedure and needs to be performed with care to prevent the formation of additional scars. Hysteroscopy is typically involved. Laparoscopy (commonly referred to as keyhole surgery) may also be used in more complicated cases. After the surgery, some doctors will recommend the placement of an intrauterine balloon to keep tissues from sticking together. Oral estrogen may also be prescribed to help induce the regeneration of uterine tissue and promote healing. 3 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013;11:118. doi:10.1186/1477-7827-11-118 Ludwin A, Martins WP, Ludwin I. Ultrasound-guided repeat intrauterine balloon dilatation for prevention of adhesions. Ultrasound Obstet Gynecol. 2019;54(4):566-568. doi: 10.1002/uog.20223 Smikle C, Khetarpal S. Asherman Syndrome. StatPearls. Treasure Island, FL. StatPearls Publishing. By Krissi Danielsson Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit