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).

Whatever the cause, intrauterine adhesions sometimes are linked to certain symptoms, such as:

When intrauterine adhesions cause symptoms like these, a woman is said to have Asherman syndrome. 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 allow a doctor to actually see the adhesions. The most accurate is hysteroscopy.

Treating Intrauterine Adhesions

If you develop scarring your treatment will depend on the circumstances. For instance, if you're having pain or other symptoms, there's no need to be treated. The same is true if you don't plan to have children. 

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. Find out why your doctor feels 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.

What about multiple D&Cs? Having this procedure more than once 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. On the other hand, if your doctor advises you to have a subsequent D& and it's clear your health depends on it, you probably should consider it, or at least get a second opinion.

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