Asherman's syndrome (AS) is an acquired uterine condition that occurs when scar tissue (adhesions) forms inside the uterus and/or the cervix.

[1] It is characterized by variable scarring inside the uterine cavity, where in many cases the front and back walls of the uterus stick to one another.

It has been reported that 88% of AS cases occur after a D&C is performed on a recently pregnant uterus, following a missed or incomplete miscarriage, birth, or during an elective termination (abortion) to remove retained products of conception.

Trauma to the basal layer, typically after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or abortion, can lead to the development of intrauterine scars resulting in adhesions that can obliterate the cavity to varying degrees.

[citation needed] Asherman's syndrome affects women of all races and ages equally, suggesting no underlying genetic predisposition for its development.

[16] Chronic endometritis from genital tuberculosis is a significant cause of severe intrauterine adhesions (IUA) in the developing world, often resulting in total obliteration of the uterine cavity which is difficult to treat.

[17] An artificial form of AS can be surgically induced by endometrial ablation in women with excessive uterine bleeding, in lieu of hysterectomy.

This is useful as mild cases with adhesions restricted to the cervix may present with amenorrhea and infertility, showing that symptoms alone do not necessarily reflect severity.

Studies show this less invasive and cheaper method to be an efficacious, safe and an acceptable alternative to surgical management for most women.

[20][21] It was suggested as early as in 1993[22] that the incidence of IUA might be lower following medical evacuation (e.g. Misoprostol) of the uterus, thus avoiding any intrauterine instrumentation.

So far, one study supports this proposal, showing that women who were treated for missed miscarriage with misoprostol did not develop IUA, while 7.7% of those undergoing D&C did.

[citation needed] Early monitoring during pregnancy to identify miscarriage can prevent the development of, or as the case may be, the recurrence of AS, as the longer the period after fetal death following D&C, the more likely adhesions may be to occur.

[22] Therefore, immediate evacuation following fetal death may prevent IUA.The use of hysteroscopic surgery instead of D&C to remove retained products of conception or placenta is another alternative that could theoretically improve future pregnancy outcomes, although it could be less effective if tissue is abundant.

[25][26] Mechanical barriers such as Womed Leaf[27] or hyaluronic acid gels can be used to prevent formation of IUA after such adhesiogenic procedures or after D&C.

[37] However, there have been no randomized controlled trials (RCTs) comparing post-surgical adhesion reformation with and without hormonal treatment and the ideal dosing regimen or length of estrogen therapy is not known.

A recent meta analysis compared different post surgical prevention barrier strategies and concluded that there was no single clearly superior treatment.

[citation needed] However, the latest randomized controlled trial, published in July 2024, demonstrated a clinically significant and meaningful improvement in a group of patients with Asherman syndrome who received the Womed Leaf mechanical barrier film compared to a control group where no adhesion prevention tool was used.

Extensive obliteration of the uterine cavity or fallopian tube openings (ostia) and deep endometrial or myometrial trauma may require several surgical interventions and/or hormone therapy or even be uncorrectable.

[49] In the case of missed miscarriages, the time period between fetal demise and curettage may increase the likelihood of adhesion formation due to fibroblastic activity of the remaining tissue.