What is Uterine Adhesion? Treatment

Uterine adhesions, medically known as Asherman’s Syndrome, are a condition that directly affects women’s reproductive health. Adhesions that form on the inner surface of the uterus can disrupt the menstrual cycle, reduce fertility, and in some cases cause severe pelvic pain. Assoc. Prof. Dr. Nazlı Korkmaz, with her experience in women’s health, diagnoses uterine adhesions and applies safe, personalized treatment methods.

What is Uterine Adhesion (Asherman’s Syndrome)?

Uterine adhesion occurs when the endometrial lining inside the uterus is damaged, causing the tissues to stick together. This condition most commonly develops after intrauterine surgical procedures or severe infections. Adhesions can partially or completely close the uterine cavity, leading to menstrual irregularities, infertility, or recurrent miscarriages.

Causes of Uterine Adhesions

Uterine adhesions can arise from various causes. The most common include:

1. Curettage and Intrauterine Procedures

• The uterine lining can be damaged during surgical curettage or after miscarriage procedures.

• Repeated curettage significantly increases the risk of adhesion formation.

2. Intrauterine Infections

• Especially following pelvic inflammatory disease (PID), the uterine lining may be damaged.

• Tuberculosis or severe bacterial infections can also increase the risk of adhesions.

3. Post-Cesarean Complications

• Though rare, scarring inside the uterine wall after a cesarean section may lead to adhesions.

4. Myomectomy or Polyp Surgery

• Removal of intrauterine fibroids or polyps may cause endometrial damage, resulting in adhesions.

5. Radiation and Chemotherapy

• Radiation therapy or certain chemotherapy treatments targeting the uterus may rarely lead to adhesions.

Symptoms of Uterine Adhesions

Symptoms vary from woman to woman. Some may have no symptoms, while others experience severe issues. The most common include:

• Menstrual irregularities: Reduced or absent menstrual bleeding

• Painful menstruation: Severe pain during periods

• Infertility: Difficulty conceiving

• Recurrent miscarriages: The embryo cannot implant properly

• Pelvic pain: Rarely, chronic pelvic pain

Assoc. Prof. Dr. Nazlı Korkmaz evaluates these symptoms, makes an accurate diagnosis, and develops the appropriate treatment plan.

Diagnosis of Uterine Adhesions

Several methods are used to diagnose uterine adhesions:

1. Hysteroscopy

• Allows direct visualization of the uterine cavity.

• Hysteroscopy can be both diagnostic and therapeutic.

• Assoc. Prof. Dr. Nazlı Korkmaz safely removes adhesions using modern hysteroscopic techniques.

2. Hysterosalpingography (HSG)

• An X-ray technique that visualizes the uterus and fallopian tubes.

• Can reveal the presence of adhesions and the shape of the uterine cavity.

3. Ultrasound and 3D Ultrasound

• Used to evaluate the thickness of the endometrium and detect possible adhesions.

4. Magnetic Resonance Imaging (MRI)

• Provides detailed information in severe or complex cases.

Degrees of Uterine Adhesions

Uterine adhesions are classified as mild, moderate, or severe depending on their extent.

• Mild adhesions: A small portion of the uterine cavity is affected; may only cause slight menstrual irregularities.

• Moderate adhesions: A significant portion of the cavity is involved; menstrual flow decreases and fertility may be affected.

• Severe adhesions: The uterine cavity is largely closed; menstruation may cease completely, and fertility is seriously impaired.

This classification is crucial for treatment planning. Assoc. Prof. Dr. Nazlı Korkmaz assesses the severity of adhesions and determines the most appropriate surgical or medical approach.

Uterine Adhesions and Menstrual Irregularities

Since adhesions interfere with the normal function of the endometrium, menstrual irregularities are common.

• Hypomenorrhea (reduced bleeding) or amenorrhea (no menstruation) are the most prominent signs.

• Painful periods (dysmenorrhea) may occur in some women.

• Women with a history of uterine surgery should be particularly cautious if experiencing cycle irregularities.

Treatment of Uterine Adhesions

Treatment depends on the severity of the adhesions and the patient’s pregnancy plans. Options include:

1. Hysteroscopic Surgery

• The most effective and safe method.

• Adhesions are cut during hysteroscopy, reopening the uterine cavity.

• Care is taken to preserve the endometrial lining.

• Assoc. Prof. Dr. Nazlı Korkmaz performs hysteroscopic surgery with expertise to maximize success rates.

2. Medication and Intrauterine Stents

• Hormonal therapy may be given after surgery to prevent new adhesions.

• In some cases, a small stent or balloon is placed inside the uterus to keep it open.

3. Follow-Up and Rehabilitation

• Regular ultrasound or hysteroscopic checks are necessary after surgery.

• 1–3 months of monitoring ensures full recovery of the endometrium.

Innovative Approaches in Treatment

Modern medicine primarily uses hysteroscopic surgery to treat adhesions. In addition:

• Hormone therapies that support endometrial regeneration help prevent recurrence.

• In some cases, biological barriers or balloons maintain the uterine cavity open.

• Assoc. Prof. Dr. Nazlı Korkmaz combines surgical and medical approaches tailored to each patient for better outcomes.

Uterine Adhesions and Pregnancy

Untreated adhesions significantly reduce the chances of pregnancy. Surgical removal of adhesions and preservation of the endometrium increase the likelihood of conception.

• Success rates are around 70–80% in mild cases.

• In moderate to severe cases, conception requires careful follow-up and more time.

Assoc. Prof. Dr. Nazlı Korkmaz treats uterine adhesions while also monitoring the pregnancy process in women planning to conceive.

Prevention of Uterine Adhesions

Although it is not always possible to prevent uterine adhesions, some measures reduce the risk:

1. Safe surgical practices: Procedures should be performed by experienced specialists.

2. Prompt treatment of infections: Pelvic infections must be diagnosed and treated in time.

3. Post-miscarriage care: Proper follow-up and hormonal support after curettage are important.

4. Postpartum monitoring: Regular follow-up after cesarean or uterine surgeries is essential.

Frequently Asked Questions (FAQ)

Do uterine adhesions always cause symptoms?

• No, some women may have no symptoms. However, infertility or menstrual irregularities should raise suspicion.

What happens if adhesions are not treated?

• Difficulty conceiving, recurrent miscarriages, and severe menstrual issues may occur.

Can adhesions recur after surgery?

• There is a risk of recurrence, but hysteroscopic surgery and proper follow-up minimize it.

Do uterine adhesions prevent pregnancy?

• Yes, especially moderate to severe adhesions can affect fertility. Surgical treatment significantly increases the chances of pregnancy.