What Is Asherman’s Syndrome-Related Pelvic Pain?
Asherman’s syndrome is a condition that develops when scar tissue forms inside your uterine cavity and binds the walls together. It can occur after trauma to your uterine lining, most commonly after a dilation and curettage (D&C) procedure. The condition’s effects range from mild uterine wall scarring to a near-complete blockage of the uterine cavity. Many women don’t know they have it until their periods change, stop or start causing pain they didn’t have before.
When enough scar tissue builds up, the walls of your uterus stick together. Your uterine lining stops functioning in those areas. Menstrual blood has nowhere to go and embryos have nowhere to attach. Mild cases affect small areas of your uterine cavity. In severe cases, your front and back walls fuse together almost entirely.
Felix Cohen, MD, FACOG diagnoses and treats uterine adhesions at Hysteroscopy Center of New York. He performs a diagnostic office hysteroscopy to confirm your adhesions before beginning any treatment.
What Causes a Need for Uterine Adhesions Treatment?
Uterine adhesions form most frequently after a D&C. More than 90 percent of Asherman’s syndrome cases follow a pregnancy-related D&C, performed after a miscarriage, incomplete abortion or retained placenta. If you have a history of retained products of conception, your risk climbs even higher. Other causes of intrauterine adhesions include:
- Surgery to remove uterine fibroids
- Correction of a uterine septum that damages your endometrial lining during the procedure
- A cesarean section complicated by a post-operative infection in your uterine cavity
- Pelvic infections, such as genital tuberculosis, affecting your uterine walls
- Endometrial sampling procedures that injure opposing surfaces inside your uterus
Your risk grows with repeated procedures, especially those performed within two to four weeks of your delivery. Dr. Cohen reviews your full surgical and obstetric history before recommending a treatment. What he finds determines where your treatment starts.
What Symptoms Point to Asherman’s Syndrome Treatment Requirement?
Pelvic pain around your expected period time with little or no bleeding is the most telling sign of Asherman’s syndrome. Scar tissue blocks the blood from exiting your uterus, building pressure inside and turning into the cramping you feel each month. If you have this pattern, along with a history of uterine surgery, get checked for abnormal uterine bleeding as well. Other symptoms of Asherman’s syndrome that should prompt you to visit Hysteroscopy Center of New York include:
- Your periods getting lighter or shorter after a uterine procedure
- No period at all after a D&C or miscarriage surgery
- Cramping around your expected cycle with no bleeding to show for it
- Two or more pregnancy losses in a row with no clear reason why
- Trouble getting pregnant even though your ovulation is regular and your sperm analysis is normal
Adhesions that give you no pain can still block embryo implantation. Using a hysteroscopy for IVF and fertility evaluation, Dr. Cohen can check your uterine cavity at every stage of your workup, not just when something feels wrong.
“If you’ve had a D&C and your period changes afterward so that it’s lighter, shorter or gone, that’s a red flag we take seriously every time,” says Dr. Cohen.
How Does Dr. Cohen Diagnose Uterine Adhesions and Pelvic Pain in NYC?
A hysteroscopy is the only test that confirms whether you have Asherman’s syndrome with certainty. An ultrasound may provide useful preliminary information, but the true extent of scar tissue only shows up with a direct camera view.
Dr. Cohen passes a hysteroscope through your cervix and sees exactly where your adhesions are and how severe they are. What he finds determines whether you need one session or multiple sessions to return your uterus to full functionality. If you have endometrial polyps or a uterine septum with adhesions, your gynecologist identifies everything with one procedure and builds your treatment plan around what he actually sees inside your cavity.
Your diagnosis and treatment often happen in the same visit, as Dr. Cohen always tries to incorporate a see-and-treat approach. If you’re traveling from Canada for treatment, Dr. Cohen’s team sends you the global and travel patient information you need before your trip. That way, you focus on your care and arrive feeling prepared and confident.
What Does Asherman’s Syndrome Treatment Involve?
Adhesiolysis is the term for the treatment to remove the scar tissue from your uterine wall through a hysteroscope. It gives your uterus back the shape it had before the scarring took hold. Dr. Cohen works through the hysteroscope the entire time, seeing exactly what to remove. He never touches your healthy endometrium. If you have fibroids alongside your adhesions, a hysteroscopic myomectomy takes care of both in the same procedure.
A study tracking infertile patients after an adhesiolysis found that every patient resumed regular menstrual cycles. The overall conception rate reached 53.6 percent after 24 months. Women with minimal adhesions experienced a 71.4 percent pregnancy rate.
“Getting it done early makes a real difference,” says Dr. Cohen. “The earlier we see you, the more we can preserve. Adhesions that have been there for months are a different problem than ones we catch early.”
What Can I Expect During My Adhesiolysis Recovery?
You’re back to normal within one or two days in most cases. Your hysteroscopy recovery timeline depends on how much scar tissue Dr. Cohen removed. Light spotting and mild cramping during your first few days are normal. After a uterine adhesions treatment, the steps Dr. Cohen takes to reduce your re-adhesion risks include:
- Placing a balloon or catheter inside your uterus after the procedure
- Prescribing estrogen therapy to stimulate the regrowth of healthy endometrial lining
- Giving you antibiotics during your barrier period to prevent infections
- Scheduling a second-look hysteroscopy at two-to-four weeks to catch any early re-adhesion
Your post-op care is as important as the procedure itself. Women who complete their hormonal support and attend their second-look hysteroscopy see significantly lower recurrence rates than those who don’t.
Frequently Asked Questions (FAQs) about Intrauterine Adhesions
Can uterine adhesions come back after treatment?
Yes; however, Dr. Cohen’s post-treatment protocol with estrogen therapy, a uterine balloon and a second-look hysteroscopy is specifically designed to prevent that.
Is adhesiolysis the same as a D&C?
No. A D&C is a blind procedure with no camera, while an adhesiolysis uses a live camera feed to allow your gynecologist to target only scar tissue.
How soon after Asherman’s syndrome treatment can I try to get pregnant?
Most women are ready to try conceiving three to six months after treatment, once the second-look hysteroscopy shows your cavity has healed fully.
Does Asherman’s syndrome always cause infertility?
It doesn’t always, but the scar tissue inside your cavity reduces your conception chances and raises your miscarriage risk. Your risks stay until the scar tissue is removed.
How many sessions does adhesiolysis take?
Mild adhesions clear in one session. If yours are severe, Dr. Cohen sits down with you before starting to explain what your treatment path looks like from beginning to end.
Why Should I Choose Hysteroscopy Center of New York for Uterine Adhesions Treatment?
Dr. Cohen trained specifically in hysteroscopic surgery and holds affiliations with Mount Sinai, NYU Langone and Lenox Hill Hospital. When abnormalities show up in your uterine cavity, his background prepares him to help you. That experience is what you want behind the scope.
Dr. Cohen and his highly trained specialists at Hysteroscopy Center of New York treat intrauterine adhesions every day, not occasionally between other procedures. Book your consultation for uterine adhesions treatment today. Visit one of three locations for your consultation: in Midtown Manhattan, Columbus Circle or Queens.