What Causes Asherman’s Syndrome?

What Causes Asherman’s Syndrome?

Asherman’s Syndrome, also referred to as intrauterine adhesions (IUA), is a condition that occurs when scar tissue forms on the lining of the uterus, often resulting in infertility.  There isn’t any one cause of Asherman’s Syndrome, but it is expected that 90% of the cases are caused by a surgical procedure, and especially D&Cs.  The main reasons for having a D&C are:

  • after a miscarriage to reduce the risk of a serious infection;
  • after childbirth to remove a retained placenta;
  • to stop excessive bleeding at birth; and
  • after termination of a pregnancy.

Thinking about this, it seems odd that a surgical procedure, which is supposed to help you, causes you further trouble… So, why is this?

A D&C (also known as ERPC, evacuation of retained products of conception) involves dilating the cervix and inserting a curette (a small medical instrument used for scraping) into the cavity of the uterus. Physical scraping (curettage) is used to remove a sample of uterus lining or fragments of placenta.  Too aggressive scraping can also remove the base layer of uterine lining tissue, known as the basal layer, particularly if the endometrium is infected or the D&C is extensive.

Once the basal layer is stripped away there are no glands left to regenerate the uterus lining during the next monthly cycle.  Without the basal layer, the remaining uterus tissue is left unprotected and scars begin to form as part of the normal healing process.  Basically the same as when you cut your finger – the skin starts regenerating and forms a scar over the wound.

In my case, an ERPC in October 2016 to remove the remains (as it is so callously called) of my missed miscarriage caused Asherman’s Syndrome.  At the time, the junior surgeon who performed my ERPC said that it was a “rather difficult” one.   I didn’t think much of it at the time, but in hindsight those aren’t the words you want to hear…  Although I don’t know this for sure, it is likely that the surgeon over-vigorously scraped my uterus and damaged it.  I also had a second ERPC in December 2016, but that was performed by a senior consultant and there wasn’t a vigorous scraping of the uterus: she went in and carefully removed the “remains”, my bean.

I had never heard about Asherman’s Syndrome, nor was I warned about the risk of getting Asherman’s before my first ERPC. I have looked at both consent forms from the two ERPCs and not once was the risk of Asherman’s Syndrome or adhesions / scarring of the uterus mentioned.  I asked why at a later date and it was explained to me that it is a less than 1% risk, so they are not obligated to mention it on the medical consent form.

I’m not sure I would have acted differently at the time because I was so desperate to remove the foetus – a miscarriage is traumatizing and walking around with a dead foetus in me added to the trauma.  All I kept thinking was: “I want it out NOW”.   That said, I would at least have wanted to know all the facts and the risks so that I could have made an informed decision.

Love,

E.

 

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