Overview of Intrauterine Adhesions

These adhesions may or may not cause symptoms lik

After having a miscarriage, many women will undergo a dilation and curettage (D&C) either by necessity or by choice.

Some women develop intrauterine adhesions (scar tissue in the uterus) after having a D&C. Intrauterine adhesions may cause no symptoms, or they may be linked to problems like:

  • infertility
  • menstrual cycle problems (for example, amenorrhea—not having menstrual cycles)
  • cyclic pelvic pain
  • recurrent pregnancy loss

    When intrauterine adhesions are accompanied by symptoms (like pain or menstrual problems), a woman is said to have Asherman's syndrome

    Questions and Answers About Intrauterine Adhesions

    Here are some questions you might have about intrauterine adhesions:

    Are Adhesions Always Caused By A D&C?

    While the majority of intrauterine adhesions are believed to occur as a complication of past D&Cs, it's also possible to develop adhesions as a result of an infection, such as genital tuberculosis. The latter is more common in developing countries than in the U.S. 

    How Will the Doctor Know If I Have Adhesions?

    Your doctor can test for adhesions using hysteroscopy, hysterosonography, hysterosalpingogram, transvaginal ultrasound, or a combination of these tests. These tests allow a doctor to see the adhesions. Hysteroscopy is the most accurate method for diagnosing intrauterine adhesions. 

    What Are My Chances of Developing Intrauterine Adhesions After A Miscarriage?

    In a meta-analysis in Human Reproduction Update912 women who had undergone a hysteroscopic evaluation within 12 months of miscarriage were evaluated. The majority of these women (86 percent) had undergone a D&C for their miscarriage.

    Results revealed that 19.1 percent of these 912 women had intrauterine adhesions.

    So this study suggests that about one in five women develop intrauterine adhesions after a miscarriage. But remember, we do not know how relevant these results are. The adhesions were detected using a hysteroscope—meaning the women with the adhesions did not necessarily have symptoms or problems linked to these adhesions. 

    In fact, according to the study, in more than half of the women with adhesions, the adhesions were reported as "mild."

    What Should I Do If My Doctor Doesn't Agree That I Need Testing?

    Ask your doctor to explain why he or she doesn't think you need the tests, and explain to your doctor why you feel you should be tested (such as if you are having recurrent miscarriages and want adhesions ruled out as the explanation).

    If you don't agree with your doctor's conclusion, you can seek a second opinion. If you are having recurrent miscarriages or infertility issues and will be seeking a second opinion, consider seeing a reproductive endocrinologist or ​a fertility specialist.

    What Kind Of Treatment Will I Need If I Do Have Adhesions?

    The specifics of treatment will vary by the circumstances. It's also important to note that treatment is only needed if a woman is having symptoms or is planning on having children.

     

    The most common treatment will be hysteroscopic resection (in which the adhesions are removed). Doctors may also recommend short-term placement of a Foley catheter after the surgery to reduce the risk that the adhesions will return. Estrogen therapy (if safe for a woman based on her medical history) is also given to promote regrowth of the uterine tissue.

    Treatment of adhesions improves the odds of a successful pregnancy in most cases, but in severe cases, the adhesions may not be treatable and may result in longstanding problems with infertility.

    My Doctor Is Recommending I Have A D&C But Now I'm Scared The Procedure Could Make Me Infertile. What Should I Do?

    Weigh the risks with the benefits, and remember that most people don't develop significant adhesions after having a D&C. Your doctor probably has a good reason for recommending a D&C, but it's always OK to ask questions and to discuss your concerns with your doctor if you're feeling hesitant. Depending on the reason why your doctor is recommending a D&C, there may or may not be alternative options.

    I Have Just Been Diagnosed With A Miscarriage And Was Contemplating Having A D&C To Speed Things Up, But I Had A D&C In My Previous Miscarriage Too. Is It Too Risky For Me To Have Another D&C?

    This concern is something you should discuss with your doctor. Multiple D&Cs do appear to increase the risk of developing uterine adhesions, but D&Cs aren't always optional and sometimes are medically necessary, so the risks have to be weighed alongside the benefits.

    If a D&C is optional in your case, you can ask about medical management of the miscarriage or choose to miscarry naturally, but this is really something to discuss with your doctor.

    A Word From Verywell

    As you can see, the symptoms of adhesions may be vague—trouble getting pregnant, recurrent miscarriagesmenstrual cycle disorders, or pain in the pelvic area.

    So it may be worth asking your doctor about testing if you have had a D&C in the past and are suffering from one or more of these signs or symptoms. 

    In the end, it is about having an open dialogue with your doctor, so you feel comfortable and informed.

    Sources:

    AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):1-7. 

    Cedars, MI. (2016). Intrauterine adhesions. In: UpToDate, Barbieri RL (Ed), UpToDate, Waltham, MA. 

    Hooker AB et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors, and long-term reproductive outcomes. Hum Reprod Update. 2014 Mar-Apr;20(2):262-78.

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