Asherman syndrome means bands of scar tissue grow inside the uterus (womb) and sometimes the cervix after an injury or infection. These sticky bands are called adhesions or synechiae. They make parts of the uterine walls stick together, shrinking the normal space inside. When the uterine lining (endometrium) cannot regrow well, periods can become very light or stop, and getting pregnant or staying pregnant can be harder. Doctors also call this problem intrauterine adhesions. NCBI+1
Asherman syndrome means scar tissue forms inside the uterus and sometimes in the cervix. These scars are called adhesions. They can partially or completely stick the front and back walls of the uterine cavity together. This may cause lighter periods, no periods, pelvic pain, trouble getting pregnant, or repeated miscarriage. The most common trigger is a surgical procedure inside the uterus—especially dilation and curettage (D&C) after a miscarriage, birth, or retained placenta—because the basal layer of the endometrium can be injured and then heals by scarring. Less common causes include genital tuberculosis and other infections. The gold-standard way to both diagnose and treat Asherman syndrome is hysteroscopy, a thin telescope that goes through the cervix into the uterus. NCBI+1
Why it happens
The inside lining of the uterus (endometrium) has a basal layer that regenerates the surface after each period or pregnancy. If that basal layer is damaged—most often by curettage in a recently pregnant uterus—the surfaces can heal by forming bands of scar tissue that bridge across the cavity. These bands may block menstrual flow and can distort where a pregnancy would implant. Adhesions can also reform after treatment, especially when scars are dense or involve a large part of the cavity, so careful prevention after surgery matters. BioMed Central+1
Common symptoms are: much lighter periods or no periods at all, cramps or pelvic pain (especially at the time a period should come), infertility, or repeated miscarriages. Some people have normal periods but still have adhesions that affect fertility or cause abnormal placental attachment in pregnancy. Symptoms do not prove the diagnosis—hysteroscopy is the best test to see adhesions directly. NCBI+1
Other names
Doctors and health sites use several names for the same condition. Common terms are Asherman syndrome, intrauterine adhesions (IUA), and intrauterine synechiae. Older or less common phrases include endometrial synechiae or uterine synechiae. All describe scars that partially or completely tie the uterine cavity together. NCBI+1
Asherman syndrome usually starts when the basal layer of the uterine lining—the layer that must regrow each cycle—is scraped, burned, or infected. The most frequent trigger is dilation and curettage (D&C) performed after a miscarriage, delivery, or abortion. Other uterine surgeries, infections like genital tuberculosis, or rare parasitic infections like schistosomiasis can also start the scarring process. NCBI+1
Types
Clinicians often group cases by how much of the cavity is scarred and how hard it is to pass a scope into the uterus. In mild disease, thin filmy bands cover small areas and periods may only be lighter. In moderate disease, thicker bands link larger areas and periods shorten. In severe disease, dense scars block major parts of the cavity or the cervix, periods may stop (amenorrhea), and fertility problems are common. Formal classifications used in practice and research (AAGL/ESGE systems) rely on hysteroscopy findings to grade extent and complexity. PMC+1
Common causes
Dilation & curettage (D&C) after miscarriage. The lining can be scraped too deeply when removing retained tissue, especially soon after pregnancy, and scars form as it heals. NCBI+1
D&C after delivery (postpartum). A recently pregnant uterus is especially vulnerable; scarring risk is higher after postpartum curettage for retained placenta. Advanced Fertility Center of Chicago™
Repeated D&C procedures. Multiple curettages increase the chance that the basal layer is damaged and adhesions develop. MDPI
Manual removal of placenta/retained products. Instrumented removal and suction after delivery or miscarriage can injure the basal layer. Bangladesh J. Fertility & Sterility
Endometrial ablation. Heat/cold/electrical energy used to treat heavy bleeding can scar the lining and close parts of the cavity. RMA Network – Fertility Clinic
Hysteroscopic fibroid or polyp removal. Removing submucous fibroids or broad-based polyps can leave opposing raw surfaces that heal together. Bangladesh J. Fertility & Sterility
Myomectomy (fibroid surgery). When the cavity is opened or lining is traumatized, adhesion risk rises. RMA Network – Fertility Clinic
Cesarean section complications. Rarely, infection or cavity entry/scarring after C-section can contribute. Advanced Fertility Center of Chicago™
Uterine infections (endometritis). Severe or chronic infections can damage the basal layer and create scars. Penn Medicine
Genital tuberculosis. In countries where TB is common, TB of the uterus is a well-known cause of dense adhesions. NCBI
Schistosomiasis. This parasite can inflame and scar the endometrium in endemic areas, rarely leading to adhesions. NCBI
Post-abortion complications. Infection or aggressive curettage after induced abortion can lead to IUA. ReproductiveFacts
Uterine artery embolization (rare association). Reduced blood flow during healing after intrauterine procedures may contribute to scarring in some cases. (Mechanistic inference supported by surgical literature on endometrial injury.) Bangladesh J. Fertility & Sterility
Uterine packing/tamponade for hemorrhage. Prolonged apposition of raw surfaces while healing may encourage bands to form. (Mechanistic inference based on adhesion biology and post-partum procedures.) Bangladesh J. Fertility & Sterility
Congenital cavity anomalies treated surgically. Adhesions can follow corrective surgery for septum or other Müllerian anomalies. RMA Network – Fertility Clinic
Radiation to the pelvis. Radiation can thin and scar the endometrium, predisposing to intrauterine synechiae. (General gynecologic oncology understanding; adhesions noted after endometrial injury.) Glowm
Severe pelvic inflammatory disease. Intense inflammation can extend into the cavity and damage the lining. PubMed
Prolonged retained products of conception. Longer time to evacuation increases fibroblast activity and scarring risk. Wikipedia
Aggressive suction settings/long suction time. Higher vacuum pressures and longer suction during uterine evacuation have been associated with more adhesions. PubMed
Any deep injury to the basal endometrium. No matter the trigger, damage to the regenerative layer is the key pathway to adhesions. PMC
Symptoms
Lighter periods (hypomenorrhea). Less lining grows and sheds each month, so flow is scant. Cleveland Clinic
No periods (secondary amenorrhea). Severe scarring can block or silence the lining, so bleeding stops. NCBI
Irregular periods. When only parts of the lining respond, cycles can shorten or vary. NCBI
Cramping with little or no bleeding. Blood trapped behind adhesions can cause pain without visible flow. NCBI
Infertility. A narrowed, poorly responsive cavity makes implantation harder. Cleveland Clinic
Recurrent miscarriage. Scarred areas can disrupt early placental attachment.
Pelvic pain. Adhesions can pull tissues or block outflow, causing cyclic pain. NCBI
Pain with intercourse (dyspareunia). Less common, but pelvic tenderness and scarring can make sex uncomfortable. Cleveland Clinic
Spotting between periods. Fragile scarred surfaces may bleed irregularly. Cleveland Clinic
Trouble with embryo transfer or IUD placement. A tight or distorted cavity can make procedures difficult. ACOG
Placental problems in pregnancy. Abnormal attachment (e.g., accreta spectrum) is more likely with scars. NCBI
Preterm birth risk or growth problems in pregnancy. Some women have higher obstetric risks after severe adhesions.
Cervical stenosis symptoms. If scars narrow the cervix, periods may be painful or blocked. NCBI
Anxiety and stress around fertility. The condition can be emotionally taxing during attempts to conceive. (Patient-reported concerns; fertility center guidance.) RMA Network – Fertility Clinic
Few or no symptoms. Mild, filmy adhesions can be silent and discovered only during fertility testing. Cleveland Clinic
Diagnostic tests
Important note in plain language: There is no “electrodiagnostic” test (like nerve or heart conduction tests) that diagnoses Asherman syndrome. Doctors rely on history, exam, imaging of the uterine cavity, and direct look with a scope (hysteroscopy), which is the gold standard. I include alternatives below so you still have a complete list of useful tests. PMC+1
A) Physical examination
General and menstrual history review. Your doctor asks about flow pattern, pain, procedures, infections, miscarriages, and deliveries to spot risk clues for adhesions. NCBI
Abdominal and pelvic exam (bimanual exam). Hands-on exam checks uterine size, tenderness, and mobility; while it cannot see scars, it guides further testing. Cleveland Clinic
Speculum exam of the cervix. Looks for scarring at the cervical opening or signs of infection that might explain symptoms. Cleveland Clinic
Pregnancy test (urine). First step for amenorrhea or irregular bleeding to rule out pregnancy before cavity testing. (Standard gyne evaluation practice.) Cleveland Clinic
B) Office/“manual” procedures
Office hysteroscopy (diagnostic). A thin camera is gently passed through the cervix to directly see adhesions; this is the gold standard test. ACOG+1
Cervical sounding/dilation attempt. Gentle probing shows if the cervix is narrowed or blocked by scars and helps plan scope access. (Common office step before hysteroscopy.) ACOG
Saline infusion sonography (SIS). Sterile saline is put into the uterus during ultrasound; gaps or bridges that do not fill suggest adhesions. RMA of New York
Endometrial sampling (pipelle biopsy). May be done if bleeding is abnormal to rule out other causes; scant tissue in an atrophic cavity can support the suspicion of adhesions. ACOG
Trial IUD or catheter passage (assessment only). Difficulty advancing a soft catheter can hint at cervical or cavity bands, guiding choice of imaging or hysteroscopy next. (Procedural inference consistent with hysteroscopic practice.) ACOG
C) Lab and pathological tests
Complete blood count (CBC). Checks anemia from abnormal bleeding and baseline health before procedures. (Standard pre-procedure care.) ACOG
Inflammation/infection screens when history suggests it. For example, genital TB testing in high-risk patients; positive results support an infectious cause of adhesions. NCBI
Hormone tests (as needed). If periods are absent, clinicians may check TSH, prolactin, or ovarian hormones to rule out non-structural causes before labeling adhesions. (Standard amenorrhea work-up.) Cleveland Clinic
Pathology of retained tissue (if evacuated). Confirms retained products of conception or chronic endometritis that can lead to scarring. Bangladesh J. Fertility & Sterility
D) Imaging tests
Transvaginal ultrasound (TVUS). First-line look at the uterus; may show a thin lining or irregular shadows, but mild adhesions are easy to miss with ultrasound alone. Cleveland Clinic
Saline infusion sonography (SIS). Enhances ultrasound by opening the cavity with fluid; filling defects and “bridges” are suggestive of synechiae. RMA of New York
Hysterosalpingography (HSG). X-ray with dye outlines the cavity and tubes; areas that do not fill, or a “stringy” outline, point to adhesions. RMA of New York
3D ultrasound. Builds a 3D view for mapping extent and location of scarring, helpful in planning treatment. ACOG
MRI of the pelvis (select cases). Rarely needed, but can show fibrotic bands or other uterine problems if ultrasound findings are unclear. Cleveland Clinic
Pregnancy ultrasound surveillance (after treatment). In future pregnancies, imaging checks for placental problems that are more likely after severe adhesions.
E) Definitive visualization
Diagnostic hysteroscopy (again, the reference test). Direct vision confirms the diagnosis, maps severity, and can often treat the scars in the same sitting. Most guidelines endorse hysteroscopy as the best test for diagnosis. PMC+1
Non-pharmacological treatments (therapies & “others”)
These are supportive or procedural measures that do not rely on a systemic medicine. Your specialist will mix and match based on severity.
Hysteroscopic adhesiolysis (key treatment)
A gynecologist uses a thin scope through the cervix to cut and gently separate scar bands under direct vision. Energy (cold scissors, bipolar electrode) is chosen to minimize heat injury. The goal is to restore a normal‐shaped cavity and reopen the uterine corners where the tubes enter. This procedure is the gold standard; it improves periods and pregnancy chances, though success is lower with severe, dense scars. Risks include perforation, bleeding, infection, and recurrence, which is why careful post-op prevention is used. PMC+2BioMed Central+2Second-look hysteroscopy
Because adhesions can reform, many surgeons schedule a short “look-back” hysteroscopy 2–8 weeks after treatment. If tiny bands are reforming, they can be divided before becoming dense. This improves cavity patency and menstrual recovery and may improve fertility outcomes in moderate-to-severe disease. PMC+1Intrauterine balloon stent (Foley catheter)
After adhesiolysis, a small silicone balloon can be left inside the uterus for several days to keep the walls apart while the lining heals. It is usually attached to the leg to avoid tension and is removed in clinic. This is widely used; the exact device and duration vary by surgeon. PMCCustom intrauterine stents (e.g., Cook balloon, framed stents)
Purpose-built stents may better fit the uterine shape and reduce focal pressure points compared with a Foley. They are another way to prevent the walls from touching during healing in severe cases. PMCHyaluronic-acid gel barrier
A viscous, bioresorbable gel (e.g., auto-cross-linked hyaluronic acid) is placed in the cavity at the end of surgery. It coats the raw surfaces so they do not stick together. Randomized data in miscarriage D&C populations and gynecologic surgery suggest it reduces adhesion incidence and severity, though it does not eliminate adhesions completely. PubMed+1Estrogen-primed endometrial regeneration (as a protocol component)
While estrogen is a drug, the “therapy” idea here is structured lining-regrowth: restore cavity shape surgically, then stimulate gentle, prompt regrowth of the endometrium so two healing surfaces do not scar together. Estrogen plus a short course of progesterone is a standard part of many post-op protocols after adhesiolysis. PMCUltrasound-guided cervical dilation
When the cervix is also scarred shut, careful, image-guided dilation during hysteroscopy reduces perforation risk and allows access to the cavity for definitive treatment. PMCOffice or outpatient “no-touch” hysteroscopy for filmy adhesions
Very thin, filmy bands in mild disease can sometimes be separated with just the tip of the scope and gentle fluid pressure. This may be done without general anesthesia, which reduces risks and costs. BioMed CentralTargeted fertility timing after cavity restoration
Once the lining and cavity are normalized, clinicians often recommend trying to conceive in the months after healing (if pregnancy is desired), because recurrence risk accumulates with time and outcomes are better when the cavity remains open. FrontiersPrevention in future procedures
If you later need uterine procedures (e.g., evacuation for miscarriage), your team can use gentle suction under ultrasound guidance and consider adhesion-prevention gels. Preventing repeat basal-layer trauma lowers the chance of recurrence. PubMed+1Saline infusion sonography monitoring
After treatment, saline ultrasound checks that the cavity is open and the lining is even. If abnormalities are seen, early re-intervention can be planned. PMCCounseling and shared decision-making
Understanding realistic pregnancy and live-birth rates, plus recurrence risk, helps people choose between repeat adhesiolysis, assisted reproduction, or other paths. Meta-analyses report conception ≈59% and live birth ≈46% after adhesiolysis overall, with lower rates in severe disease. Frontiers+1Pain management (non-opioid)
Temporary cramps after surgery can be managed with NSAIDs and local measures like heat pads. This reduces stress hormones that can impair early healing behaviors and sleep. (Medication safety individualized.) PMCScreening and treatment of genital infections (context-specific)
In regions where genital tuberculosis is prevalent, clinicians evaluate and treat active infection around the time of adhesiolysis to reduce reinjury and re-scarring. NCBIPelvic floor relaxation and gentle movement
While adhesions form inside the uterus, pelvic physical therapy may reduce guarding, improve comfort, and support sexual function during recovery. (Adjunctive; not a cure for IUAs.) PMCOptimizing iron and anemia care
If periods were obstructed and later resume, some people experience heavier bleeding transiently. Checking hemoglobin and iron stores and treating iron deficiency supports energy and healing. PMCPreconception planning
After successful cavity restoration, a pre-pregnancy visit addresses folate, thyroid, diabetes screening, and review of obstetric risks such as abnormal placentation. PMCEarly obstetric surveillance in the next pregnancy
Asherman syndrome increases risks like placenta accreta spectrum in some cases; early ultrasounds assess implantation site and placental invasion so care can be planned. PMCMental health support
Infertility and pregnancy loss are emotionally heavy. Brief counseling and peer support reduce anxiety and improve adherence to follow-up plans. PMCSpecialist referral pathways
Complex or recurrent cases benefit from centers with high-volume hysteroscopy expertise and access to advanced stents and gels; outcomes and complication rates are better with experienced teams. PMC
Drug treatments
Medicines in Asherman syndrome mainly support surgery and healing. None can “melt” dense scars. Doses below are typical ranges—your clinician will individualize.
Estradiol (oral 2–4 mg/day for 30–60 days) + short progesterone add-back
Class: Estrogen (with progestin for withdrawal bleed).
Why/when: Start after adhesiolysis to regrow a healthy lining and keep raw surfaces from sticking together.
How it works: Estrogen stimulates endometrial proliferation; adding progesterone for 7–10 days causes a scheduled bleed and organized shedding.
Side effects: Breast tenderness, nausea, headache; risks higher in smokers or with clot risk—screen first. PMCMedroxyprogesterone acetate (10 mg/day × 7–10 days per cycle)
Class: Progestin.
Why/when: Added after an estrogen phase to stabilize and organize the endometrium and trigger a predictable bleed.
Mechanism: Converts proliferative lining to secretory, then withdrawal bleeding clears old blood.
Side effects: Mood change, bloating, breast tenderness. PMCDydrogesterone (10 mg twice daily × 7–10 days)
Class: Progestin.
Use: Alternative to medroxyprogesterone for add-back; chosen for tolerability in some settings.
Mechanism/SE: As above. PMCEstradiol transdermal patches (e.g., 50–100 µg/day)
Class: Estrogen.
Use: For patients who prefer patches or have GI side effects with oral pills; same healing principle.
Side effects: Skin irritation; same estrogen cautions. PMCAntibiotics (only if infection is present or strongly suspected)
Class: Antimicrobials tailored to organism (e.g., TB regimen where prevalent).
Use: Treat active genital infection that may worsen scarring or complicate surgery.
Mechanism: Eradicates pathogens; prevents inflammatory damage.
Side effects: Drug-specific; TB drugs require careful monitoring. NCBINSAIDs (e.g., ibuprofen 400–600 mg as needed)
Class: Non-steroidal anti-inflammatory.
Use: Pain after hysteroscopy; improves comfort and function.
Mechanism: COX inhibition reduces prostaglandin-mediated cramps.
Side effects: Dyspepsia, renal risk with heavy use; avoid late pregnancy. PMCTranexamic acid (e.g., 1 g orally every 8 hours during heavy bleeding days)
Class: Antifibrinolytic.
Use: If periods are heavy after cavity restoration.
Mechanism: Stabilizes clots by blocking plasminogen activation.
Side effects: Nausea; very rare clot risk—avoid with history of thrombosis unless approved. PMCVaginal estrogen (e.g., estradiol 25 µg twice weekly after the initial course)
Class: Local estrogen.
Use: In selected patients to support cervical and lower-segment healing with minimal systemic exposure.
Mechanism: Local trophic effect on mucosa.
Side effects: Local irritation. PMCAntibiotic prophylaxis (selective, per surgeon protocol)
Class: Single-dose peri-procedural antibiotic.
Use: Some centers give a one-time dose at surgery; practice varies due to limited evidence.
Mechanism: Lowers bacterial inoculum during instrumentation.
Side effects: Drug-specific; stewardship matters. PMCLow-dose aspirin (only when specifically indicated)
Class: Antiplatelet.
Use: Sometimes used in fertility protocols for endometrial perfusion; evidence is mixed and not routine.
Mechanism: Platelet inhibition and microcirculation effects (hypothesized).
Side effects: Gastric upset, bleeding risk—prescriber discretion. PMCGnRH agonists (generally not routine for Asherman)
Class: Hypothalamic analog.
Use: Not standard; may be considered in select complex protocols but lacks strong evidence for adhesion prevention.
Side effects: Hypoestrogenism (hot flushes, bone loss). PMCCombined estrogen-progestin pills (cyclic for 1–2 months post-op)
Class: Combined hormonal contraceptive.
Use: An alternative to separate estradiol + progestin where simple cyclic therapy is preferred; timing with fertility goals is important.
Side effects: As for CHC; screening is essential. PMCTopical intrauterine hyaluronic-acid (device/gel; applied by the surgeon)
Class: Barrier adjunct (device/implantable gel).
Use: Placed intraoperatively; although not a “systemic drug,” it is a product used to reduce new scar formation.
Side effects: Rare cramping/discharge; resorbs spontaneously. PubMedAntibiotics for pelvic TB (region-specific multidrug regimen)
Class: Anti-TB combination (e.g., isoniazid, rifampin, ethambutol, pyrazinamide per guidelines).
Use: Documented genital TB causing IUAs.
Mechanism: Eradication of mycobacteria to prevent continued injury.
Side effects: Drug-specific; liver monitoring. NCBIProgestin-only pills (short course add-back)
Class: Progestin.
Use: For patients who cannot take estrogen; limited evidence for cavity outcomes compared with estrogen-based regrowth.
Side effects: Irregular spotting, mood changes. PMCAntimicrobial vaginal preparations (only for proven infections)
Class: Local antibiotics/antiseptics.
Use: Treat documented cervicitis/vaginitis around the time of surgery; not for routine prevention.
Side effects: Irritation; yeast imbalance. PMCIron therapy (oral ferrous sulfate 325 mg every other day, or IV iron if needed)
Class: Hematinic.
Use: Correct iron-deficiency anemia from disordered bleeding.
Mechanism: Restores iron stores for red blood cell production.
Side effects: GI upset with oral iron; constipation. PMCFolic acid (400–800 µg/day preconception)
Class: Vitamin.
Use: Standard preconception care after cavity restoration; prevents neural tube defects.
Side effects: Rare; water-soluble. PMCShort antibiotic course after instrumentation (select protocols)
Class: Antibacterial.
Use: Some centers prescribe a brief course post-op; evidence is limited, so practices vary.
Side effects: Drug-specific; aim to avoid unnecessary use. PMCAnalgesic ladder (acetaminophen → NSAID)
Class: Analgesics.
Use: Comfort after hysteroscopy to enable early mobilization.
Side effects: As labeled; avoid excess acetaminophen and NSAIDs if contraindicated. PMC
Dietary molecular supplements
Supplements may support general reproductive health and anemia recovery but do not replace surgery for adhesions.
Iron (elemental 45–65 mg every other day if deficient)
Helps rebuild hemoglobin if heavy or irregular bleeding caused anemia. Alternate-day dosing can improve absorption and reduce stomach upset. Confirm deficiency with labs; avoid unnecessary iron. PMCFolate (400–800 µg/day)
Standard preconception support after the cavity is restored; reduces neural tube defects and supports cell division in the endometrium. PMCVitamin D (target 25-OH level per local lab; typical 1,000–2,000 IU/day)
Low vitamin D is common and correcting it supports general reproductive and immune health, though it does not treat adhesions. PMCOmega-3 (EPA/DHA ~1 g/day with meals)
May modestly reduce inflammatory signaling and menstrual discomfort post-op; choose mercury-tested products. PMCVitamin B12 (if low; oral 1,000 µg/day or IM per clinician)
Corrects deficiency-related anemia and supports cell turnover. Test before supplementing. PMCVitamin C (200–500 mg/day)
Supports iron absorption and collagen synthesis during healing; do not exceed high doses that cause GI upset. PMCZinc (8–15 mg/day)
Involved in tissue repair and immunity; stick to modest doses to avoid copper deficiency. PMCIodine (only if deficient; follow local guidance)
Supports thyroid function, which is important for fertility; excess can harm—use only if advised after testing. PMCCoenzyme Q10 (100–200 mg/day with fat-containing meal)
Explored in fertility settings for mitochondrial support; quality evidence for Asherman specifically is limited. PMCProbiotics (lactobacillus-dominant vaginal health)
May help maintain a favorable genital tract microbiome around surgery (adjunct only). Choose clinically studied strains. PMC
Immunity-booster / regenerative / stem-cell” therapies
These are emerging; talk with a specialist and consider trials. Evidence is evolving.
Platelet-rich plasma (PRP) intrauterine infusion
Autologous PRP delivers concentrated growth factors to the uterine lining after adhesiolysis to promote regeneration. Early studies suggest improved endometrial thickness and menstrual recovery, but large randomized trials are limited. ScienceDirectBone marrow–derived stem cell therapy (investigational)
Stem cells infused into the uterine cavity aim to repopulate damaged basal endometrium. Case series show promise in severe, recurrent Asherman syndrome, but risks, durability, and pregnancy safety need robust trials. ScienceDirectUmbilical cord mesenchymal stem cells (trial settings)
Allogeneic cells may be seeded on a scaffold or infused; the goal is to reduce fibrosis and stimulate healthy lining. Still experimental. ScienceDirectGrowth-factor gels/scaffolds
Bioactive matrices (sometimes hyaluronic-acid based) that release growth factors could support orderly healing and reduce re-adhesion. Evidence is early. ScienceDirectAutologous peripheral blood mononuclear cells (pilot research)
Cells are delivered into the uterus to modulate inflammation and healing; currently investigational. ScienceDirectLow-intensity intrauterine physical energy therapies (research phase)
Techniques under study try to modulate fibrosis biology; not standard of care. ScienceDirect
Surgeries
Operative hysteroscopic adhesiolysis (primary surgery)
Procedure: Through the cervix, the surgeon precisely cuts scar bands under direct vision until a normal cavity shape and tubal ostia are restored.
Why: It is the only established way to remove adhesions and rehabilitate the cavity. PMCSecond-look hysteroscopy (minor re-operation if needed)
Procedure: A brief follow-up scope to lyse early, reforming bands.
Why: Reduces dense recurrence and preserves cavity patency. PMCUltrasound-guided adhesiolysis
Procedure: Real-time ultrasound guides instrument direction, improving safety in distorted cavities.
Why: Lowers perforation risk and helps confirm cavity shape. PMCLaparoscopy-assisted hysteroscopy (selected severe cases)
Procedure: A tiny camera through the abdomen watches the uterus while hysteroscopy proceeds.
Why: Adds safety when the cavity is obliterated or perforation risk is high. PMCCesarean scar niche and placental disorder management (future pregnancy)
Procedure: If niche or accreta is suspected, surgery is planned with a high-risk obstetric team.
Why: Asherman history can associate with abnormal placentation; planned care reduces hemorrhage risk. PMC
Preventions
Use ultrasound guidance and gentle suction techniques for D&C when possible. ASRM
Avoid unnecessary curettage; consider medical management of miscarriage when safe and acceptable. ASRM
Consider hyaluronic-acid gel after D&C in high-risk settings to reduce adhesions. PubMed
Promptly treat genital and pelvic infections before uterine procedures. NCBI
After adhesiolysis, follow your post-op plan (hormones, stent, follow-up visit). PMC
Keep the second-look hysteroscopy appointment if recommended. PMC
Choose experienced hysteroscopy centers for complex cases. PMC
Discuss future pregnancy planning and early obstetric care to detect placental issues. PMC
Manage anemia and nutrition to support healing. PMC
Stick to evidence-based add-ons; avoid unproven remedies that may delay effective care. PMC
When to see a doctor
Your periods become very light or stop after a uterine procedure (miscarriage treatment, postpartum D&C, or fibroid surgery).
You have pelvic pain at “period time,” especially with scant bleeding.
You have trouble getting pregnant or have repeated miscarriages.
You are planning a pregnancy after adhesiolysis and need early pregnancy monitoring.
You live in or are from an area where genital tuberculosis is common and have menstrual changes after a uterine infection. NCBI+1
What to eat and what to avoid
Iron-rich foods (lean meats, beans, leafy greens) to restore iron if anemic; pair with vitamin-C-rich foods. PMC
Adequate protein (eggs, fish, legumes) to support tissue repair. PMC
Whole grains and fiber for bowel regularity when using iron or pain meds. PMC
Hydration to ease cramps and support recovery. PMC
Limit alcohol and smoking—they impair healing and fertility. PMC
Avoid very high-dose supplements unless prescribed (e.g., excess vitamin A, iodine). PMC
Balanced fats with omega-3 sources (fish, walnuts). PMC
Moderate caffeine if it aggravates cramps or sleep after surgery. PMC
Food safety if you conceive soon: avoid unpasteurized foods and undercooked meats. PMC
Prenatal-style nutrition once cleared to try for pregnancy, including daily folate. PMC
What outcomes can you expect?
Overall, studies suggest ~59% conception and ~46% live birth after hysteroscopic adhesiolysis, but results vary by severity. Mild, filmy adhesions have high success; severe, dense adhesions have lower success and higher recurrence, sometimes requiring multiple procedures. Individual prognosis depends on age, ovarian reserve, other fertility factors, and how much of the uterine cavity was involved. Frontiers+2ScienceDirect+2
Frequently asked questions (FAQs)
1) Can medications alone cure Asherman syndrome?
No. Medicines can help the lining regrow and reduce re-scarring after surgery, but they cannot dissolve dense adhesions. Hysteroscopic adhesiolysis is the proven treatment. PMC
2) Do I always need a balloon or gel after surgery?
These are common tools to lower recurrence risk; your surgeon chooses based on adhesion severity and cavity shape. Evidence supports hyaluronic-acid gel and mechanical separation in higher-risk cases. PubMed
3) How soon can I try to conceive after adhesiolysis?
After healing and your doctor’s clearance—often after one or two cycles with check-up imaging or second-look hysteroscopy—trying sooner rather than much later may help reduce re-adhesion risk. PMC
4) What are the chances of recurrence?
Recurrence depends on severity and type of scar: filmy ~2–4%, dense up to ~30% in some series; greater cavity involvement also raises risk. Early follow-up helps catch small bands. BioMed Central
5) Will my period come back?
Many people see periods return after successful cavity restoration; return of flow is a positive sign but not the only measure of success. PMC
6) Is pregnancy safe after Asherman surgery?
Most people can have safe pregnancies with early monitoring. There is some increased risk of abnormal placental attachment; plan early obstetric care. PMC
7) Are copper IUDs used to prevent re-adhesion?
Guidelines favor balloons or purpose-built stents rather than copper IUDs because IUDs can irritate the lining and do not conform to all cavity shapes. Practices vary by surgeon and case. PMC
8) Do I need antibiotics after surgery?
Routine prolonged antibiotics are not universally recommended; many centers use only a single peri-procedural dose or none, unless infection is present. PMC
9) Are there official guidelines?
Yes. The AAGL/ESGE Practice Guidelines are widely cited; they outline diagnosis, surgical technique, and prevention strategies. PMC+1
10) What if hysteroscopy cannot find the cavity opening?
Experienced surgeons may use ultrasound or laparoscopy guidance. In very severe cases, staged procedures are safer. PMC
11) Do classification systems matter?
Yes. Classifications grade extent and density, help predict outcomes, and guide counseling; new scoring systems are being proposed to improve prediction. PMC+1
12) Can Asherman syndrome happen without any surgery?
Rarely, after severe infection or genital tuberculosis, adhesions can form without a prior procedure. NCBI
13) Does a normal ultrasound rule out adhesions?
No. Ultrasound can miss mild adhesions; hysteroscopy is the definitive test. PMC
14) Is IVF needed after adhesiolysis?
Not always. Many conceive naturally once the cavity and lining are normal. IVF can help if there are other fertility factors (age, tubes, sperm) or if time is limited. Frontiers
15) What should I ask my surgeon?
Ask about their experience and volumes, planned prevention steps (balloon/gel/hormones), timing of second-look hysteroscopy, and what outcomes to expect in your severity category. PMC
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: September 24, 2025.
