Asherman’s Syndrome

Fibrotic scarring in the uterine cavity called adhesions

Asherman’s syndrome is due to fibrotic scarring in the uterine cavity called adhesions. This condition is usually due to surgical procedures involving the uterus such as a ‘D&C’ (more accurately called a hysteroscopy). It can also be due to hysteroscopic resection of fibroids and laparoscopic and open myomectomy where the cavity is entered. Myomectomies can also cause furring up of the fallopian tubes due to a similar pathological situation, i.e. fibrotic scarring.

Asherman’s can cause a number of problems including infertility, miscarriage, painful periods due to the fibrosis blocking the exit of blood, and others. Asherman’s is normally diagnosed by a test called a hysterosalpingogram where dye is injected into the uterine cavity and then confirmed with hysteroscopy. Because uterine artery embolization, if done correctly, does not affect the normal uterine tissue, Asherman’s syndrome is not a realistic complication of the procedure. Obviously, uterine artery embolization needs to be performed by an experienced radiologist in the same way that surgical procedures need to be performed by somebody who is experienced in the technique. In my view, it is necessary to have done at least 50-100 uterine artery embolizations to consider yourself experienced in the technique. In the early days of uterine artery embolization when the technique of doing the procedure was really in its infancy, there were some cases of Asherman’s syndrome described and these were due to over embolization of the uterus, i.e. a failure of technique.

The bottom line is that Asherman’s syndrome and scarring of the fallopian tubes is not a significant complication of fibroid embolization compared to surgery.