Asherman’s syndrome is a condition where adhesions form in the endometrial lining of the uterus, often causing secondary amenorrhea, infertility, or repeated spontaneous abortion. Causes include endometritis, aggressive curettage (D&C) to treat menorrhagia, removal of retained placental fragments, or termination of pregnancy. Scar tissue that forms inside the uterus can lead to menstrual disturbances, infertility, and recurrent miscarriages. If you suspect you have Asherman’s syndrome or experience symptoms such as unusually light periods, difficulty conceiving, or recurrent pregnancy loss, consult a reproductive endocrinologist.

A word of caution: Ensure a board-certified reproductive endocrinologist provides any fertility diagnosis or treatment.

Medical History and Symptoms Assessment: Your reproductive endocrinologist will begin by taking a detailed medical history and reviewing any symptoms you have experienced. Common symptoms of Asherman’s syndrome include changes in menstrual flow, pelvic pain, and fertility issues.

Physical Examination: Your provider may perform a physical examination, including a pelvic exam, to check for physical abnormalities or signs of scarring in the uterine cavity.

Imaging Studies: Your provider may use transvaginal ultrasound or hysterosonography (saline-infused ultrasound) to visualize the uterine cavity and identify abnormalities such as adhesions, polyps, or fibroids. These imaging studies provide important initial information.

Hysteroscopy: Clinicians consider hysteroscopy the gold standard for diagnosing Asherman’s syndrome. During this minimally invasive procedure, the provider inserts a thin, lighted instrument called a hysteroscope through the cervix into the uterus, allowing direct visualization of the uterine cavity and identification of adhesions, scar tissue, or other abnormalities.

Hysterosalpingography (HSG): During HSG, the provider injects a contrast dye into the uterus and fallopian tubes and then takes X-ray images to visualize the uterine cavity and identify abnormalities, including adhesions.

MRI (Magnetic Resonance Imaging): In some cases, your provider may recommend an MRI to obtain a more detailed and comprehensive view of the uterine cavity, especially when hysteroscopy or HSG does not provide clear results.

Once a reproductive endocrinologist diagnoses Asherman’s syndrome, you can discuss treatment options with your specialist. Treatment may include hysteroscopic surgery to remove adhesions and restore the normal uterine cavity. In some cases, your provider may prescribe estrogen therapy after surgery to promote healing and regeneration of the uterine lining.

Consult a healthcare professional if you suspect you have Asherman’s syndrome or experience reproductive health issues. Early diagnosis and appropriate treatment can improve your chances of managing the condition and achieving your reproductive goals.

NOTE: Complete all fertility testing with a reproductive specialist. A reproductive specialist treats infertility exclusively and does not deliver babies. A board-certified M.D. who has completed a fellowship in Reproductive Endocrinology should conduct the testing. The American Society for Reproductive Medicine (ASRM) recommends that each physician supervise a minimum of 20 follicular recruitment cycles per year. Additionally, ensure access to a reproductive surgeon who specializes in treating obstructions, endometriosis, uterine abnormalities, and other reproductive organ disorders that require surgical repair using laparoscopic microsurgery techniques.