PERTH GYNAECOLOGIST

Asherman’s Syndrome

Dr Richard Murphy

Asherman’s Syndrome

Asherman’s Syndrome is a condition caused by damage to the endometrial cavity and in particular the endometrial lining of the uterus. The condition can cause problems with your periods and with fertility.

Obstetrics and gynaecology consultations at my private practice in Subiaco.

Fertility consultations at Genea Hollywood Fertility

Delivering at the Labour Ward of SJOG Subiaco Hospital

Gynaecologist Perth for Asherman's

What is Asherman's Syndrome?

Asherman’s Syndrome is an uncommon iatrogenic condition, ie it is almost always caused by medical intervention. When you have this condition there is scar tissue inside your uterus or cervix which can alter the shape of the uterus and prevent normal endometrial function. Asherman’s Syndrome causes a change in menstrual flow: lighter periods or no menstruation at all. Critically the sundrome can lead to difficulties falling pregnant.

Causes

Any surgical procedure instruments used inside the uterus can cause Asherman’s Syndrome but some are much more likely to do so. The highest risk occurs with procedures done just after pregnancy has finished and your uterus is involuting, reverting back to its normal size and shape. Any surgical procedure inside the uterus at any time can cause problems though.

A simple first trimester D+C for miscarriage is unlikely to cause this uncommon condition, but multiple D+C’s over a lifetime will increase the risk. Other procedures such as surgical treatment of fibroids or congenital uterine abnormalities can also cause Asherman’s Syndrome.

"I believe that prevention is the best option where possible and hence perform high risk hysteroscopic surgeries such as retained products after pregnancy under direct vision. I also regularly offer medical treatment for miscarriage, not just surgical D+C."

Dr Richard MurphyPerth Gynaecologist
Asherman's syndrome Perth
Of course, a lack of or change in your periods doesn’t mean you have Asherman’s Syndrome. There are many causes for lack of periods and these possibilities will be considered in your consultation.

Diagnosing Asherman's

Asherman’s Syndrome diagnosis

Asherman’s Syndrome may sometimes be diagnosed with standard ultrasound or your doctor may ask you to do a saline infusion sonogram; that is an ultrasound where fluid is inserted into the endometrial cavity. CT and MRI are usually less able to detect endometrial changes. The gold standard for diagnosis is hysteroscopy.

What is a hysteroscopy?

Hysteroscopy is a surgical procedure performed under general anaesthesia where a camera is inserted through the cervix. The aim is to examine the inside of the cervix, the endometrial cavity and the openings to the tubes on either side. It can be either diagnostic (just looking), or operative (when small instruments are passed through the device). Operative hysteroscopy means we can precisely treat any pathology and avoid damaging normal tissue.

Treating this condition

Managing Asherman’s Syndrome

The best course to manage this condition is prevention. Clinical awareness of high-risk situations is crucial in order to minimise the risks. If surgery is really needed then the gentlest procedure possible should be performed. Surgery under direct vision, using an operative hysteroscope, is usually better than old-fashioned “blind” procedures.

Fertility Specialist at Genea Hollywood

Asherman’s Syndrome and fertility

If you have this condition and you wish to conceive then restoration of the uterine cavity is needed, aiming for the return of a normal endometrial size and shape. This will be done with an operative hysteroscopy under direct vision. Additional treatments may include antibiotics, estrogen hormones, an IUD and anti-adhesion barriers such as Oxiplex and Hyaluronic acid.

"If you want to fall pregnant, a carefully considered surgical correction of your uterus is essential. With patient, carefully considered treatment most women with Asherman’s Syndrome should be able to conceive and deliver a baby."

Dr Richard Murphy, Perth Gynaecologist

The avoidance of any further procedures which can re-injury the endometrium is critical. Once already damaged it is easier to cause further damage and injury.

For more information, visit the International Asherman’s Association

Fertility Specialist & Gynaecologist in Perth

Why Dr Richard Murphy?

I am passionate about preventing this condition and very much desire to help you and your family, if you are afflicted by this very difficult condition. If you think you may have Asherman’s Syndrome then please come to see me so we can work together to help you complete your family.