Intrauterine Adhesions (Asherman Syndrome)

The Role of D&Cs in Scarring of the Uterus

Intrauterine adhesions are areas of scar tissue on the walls of the uterus that usually develop after a woman has a dilation and curettage (D&C)—a procedure to clear the uterus of pregnancy tissue that wasn't expelled during a miscarriage. A 2014 study found that about one in five women develop scarring after a miscarriage. Less often, intrauterine adhesions result from an infection, such as genital tuberculosis (more common in developing countries than in the United States).

Common Symptoms Linked to Intrauterine Adhesions

When intrauterine adhesions cause symptoms like these, a woman is said to have Asherman syndrome, which commonly occurs after a surgery like a D&C. There are a number of ways to detect scar tissue on the walls of the uterus, including hysteroscopy, hysterosonography, hysterosalpingogram, transvaginal ultrasound, or a combination. Each of these tests allows a doctor to actually see the adhesions. The most accurate is hysteroscopy, a procedure in which a thin, lighted tube is inserted into the vagina to examine the cervix and inside of the uterus.

Treating Intrauterine Adhesions

If you develop uterine scarring, your treatment will depend on the circumstances. For instance, if you don't plan to have children, there's no need to be treated surgically.

The most common treatment for intrauterine adhesions is hysteroscopic resection, in which the scars are removed. Afterward, your doctor may recommend short-term placement of a Foley catheter to reduce the risk that the adhesions will return. You also may be given estrogen therapy to promote regrowth of the uterine tissue. If you've been trying unsuccessfully to conceive and it's suspected that scarring is the reason, you may be able to get pregnant after this procedure.

Should a Woman Avoid a D&C After a Miscarriage?

If you lose a pregnancy and your doctor advises you to have a D&C, you may worry that the procedure will leave behind scars and prevent you from getting pregnant again. Talk to your doctor and ask why they feel it's important to have the D&C. Be aware that most women do not develop significant adhesions after having one, and then weigh the risks and benefits with your caregiver. However, having multiple D&C procedures does appear to increase the risk of developing uterine adhesions, so you may want to avoid more than one D&C if it's not medically necessary.

A Word From Verywell

If you've been diagnosed with uterine scarring, you're clearly already regularly seeing and communicating with your doctor. Take the opportunity to raise any questions and concerns you have about receiving a D&C or other surgical procedure. If your doctor does advise you to have a D&C and it's clear that your health depends on it, you should at least get a second opinion before deciding to forgo it altogether.

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