Asherman’s syndrome is caused by damage to the uterus that causes the formation of adhesions (scar tissue). The extent of damage can vary, and there are different grades of Asherman’s syndrome severity. The adhesion formation can affect the cervix, uterine lining, the deeper layers of the uterus, or in some cases the opening of the fallopian tubes. The scar tissue may be thin or thick. In some cases the front and back of the uterus may be adhered together, the opening to the fallopian tubes scarred shut, or the cervix covered over with scar tissue. Severe Asherman’s may lead to complete blockage of menstrual blood (endometrial lining) from being shed naturally each menses. This may lead to the formation of endometriosis, another painful and debilitating fertility issue.
Causes of Asherman’s Syndrome
The number one cause of Asherman’s syndrome is D&C (dilation and curettage) procedure. According to the International Asherman’s Association, 90% of Asherman’s cases are due to pregnancy related D&C. Women who have had a D&C 2-4 weeks post-delivery, due to retained placental reminants have up to a 25% risk of developing Asherman’s. D&C performed for missed miscarriage have a 30.9% chance of developing Asherman’s, where as women who have had a D&C due to an incomplete miscarriage only have a 6.4% chance of developing Asherman’s. Women who have had more than 2 D&C’s have an increased chance of developing Asherman’s by 32%.
Study Shows Repeated D&C Increases Risk of Developing Asherman’s Syndrome
A study, published in Human Reproduction, evaluated 50 women ages 19-44, through hysteroscopy, to determine the presence of uterine adhesions after a required second D&C due to either remaining placental remnants following delivery, missed miscarriage or medical abortion. Of the 50 women, 20 (40%) had developed intrauterine adhesions. Of that 40%, 75% had developed grade II-IV, grade IV being the most severe.
Surgical procedures that may lead to Asherman’s Syndrome:
- D&C for miscarriage, incomplete or missed
- D&C for retained placenta
- Suction method D&C
- Hysteroscopic myomectomy (removal of submucosal uterine fibroids bulging into uterine cavity)
- Cesarean section
- Uterine artery embolization (procedure to block blood flow to uterine fibroids, with the intent to shrink them)
- Vacuum procedure performed for abortion, this rarely happens
- IUD (intrauterine device birth control), this rarely happens
Non-surgical procedures that may cause Asherman’s Syndrome:
- Retained placenta requiring manual removal
- Uterine packing with gauze to prevent postpartum hemorrhage
- Douching with a caustic chemical to induce abortion
- Endometrial tuberculosis
- Pelvic irradiation for cancer treatment
Thoughtful Preparation Prior to Choosing D&C
Plan ahead for the possibility of miscarriage. If you are trying to conceive, consider the fact that early miscarriage is quite common. This does not mean go overboard and worry, or have it on your mind constantly. This means educate yourself now on ways to help prevent scar tissue and adhesion formation. If you were to experience a miscarriage, would you want a D&C, or a natural miscarriage? It may be best to let your body do the work of naturally cleansing the pregnancy loss, rather than have a D&C. Most women’s bodies are perfectly capable of miscarrying naturally on their own. D&C runs the risk of causing Asherman’s syndrome and should only be performed when medically necessary. Some studies suggest that the use of the drug Misoprostil for missed or incomplete miscarriage, or retained placenta after childbirth, lowers the risk of developing Asherman’s. This is because Misoprostil is a medication that causes the uterus to slough off the endometrium on its own.
If your doctor suggests D&C procedure for a missed miscarriage, or incomplete miscarriage, consider natural therapies that will greatly help to prevent scar tissue and adhesion formation.
Medical Procedures for Asherman’s Syndrome
Depending on the extent of adhesion formation within the uterus, a doctor may recommend surgery to remove the scar tissue. This may potentially lead to more adhesion formation, but for women who have severe damage to their reproductive organs, it may be an effective option. Doctor’s cut, or use resectoscopes or lasers to remove scar tissue patches and adhesions from inside of the uterine cavity. Some doctor’s prescribe estrogen hormone replacement to prevent new adhesion formation. This is meant to regrow the endometrium. A ballon is placed in the uterine cavity as a splint to help the uterus retain its shape. This splint is often used in combination with estrogen therapy. Many patients are asked to come in weekly for hysteroscopy to remove new adhesion growth. All of this is very invasive and while it may remove scar tissue that is present, it may also be causing more damage. There is also an increased risk of infection with these types of procedures.
If it is determined a surgical procedure is needed to remove adhesion formation from the uterus, natural therapies may be a complimentary approach to healing. Below are some wonderful complimentary healing methods, not only for prevention, but healing of Asherman’s as well.
Natural Prevention and Healing of Asherman’s Syndrome
Systemic Enzyme Therapy for Scar Tissue Prevention
Systemic Enzyme Therapy using systemic enzymes helps the body to break-down and prevent scar tissue formation. If you know that you are going for a D&C procedure, consider having a systemic enzyme blend on hand for post-procedure healing. Beginning systemic enzymes after bleeding has stopped, after D&C, may help to prevent scar tissue from forming. This may help prevent Asherman’s syndrome.
How systemic enzyme blends eliminate and prevent scar tissue:
- The systemic enzyme blend works as a biological response modifier; working with the bodies own immune defense system to moderate inflammatory response.
- They support cleansing of the tissues, promote better circulation.
- They break down and remove “fibrin”, the make-up of prolonged inflammation and scar tissue/adhesion formation.
- They break down the proteins in the blood that cause inflammation, this facilitates their removal via the lymphatic and circulatory system.
- Reduction in inflammation , increase in proper blood formation, increase in proper circulation hinders scar tissue and adhesion formation, while reducing pain.
Systemic Enzyme Therapy using systemic enzymes are most effective when used for 2 months after D&C to help prevent Asherman’s. The sooner they are begun after the procedure the more effective they will be. Systemic enzyme blends must be take on an empty stomach 45 minutes to 1 hour, prior to eating, or 1-2 hours after consuming a meal to be effective. Drink with at least 8oz of water. It is better to take your dosage spread out in the day rather than all at once. Do not use during heavy bleeding times. Discontinue use 2 weeks prior to any type of surgical procedure.
In one study the herb Shatavari (Aspargus racemosus) was shown to increase phagocytic activity of macrophages in turn reducing intraperitoneal adheshions. These are adhesions within the abdomen specifically. Macrophages have been shown to play a role in adhesion development. But this is just one study, if Shatavari can increase phagocytic activity of the macrophages there is hope for it in reducing adhesions in the entire body. This may be great news for women suffering from adhesion damage causing fertility issues.
Support a Healthy Uterus
Ensuring that you have a strong, healthy uterus prior to any surgical procedure involving the uterus, may help to prevent Asherman’s!
Self Fertility Massage
Self Fertility Massage is one of the easiest and most cost effective ways to improve uterine health, break-up and prevent adhesion formation, and promote healing of the uterus. Plus it can be done from the comfort and privacy of your own home. Not only can you do both Self Fertility Massage and Castor Oil packs prior to any surgical procedure to improve uterine health, you can do it after those procedures to prevent adhesion formation. If you have already been diagnosed with Asherman’s, I highly suggest this non-invasive healing therapy!
How does Self Fertility Massage Prevent and Heal Asherman’s Syndrome?
- Massage helps to break up scar tissue/adhesion formation
- Helps the uterus to rid itself of old stagnant blood and tissues
- Brings fresh oxygenated blood to the uterus
- Helps to strengthen the uterine muscles
- Reduces inflammation
- Helps the body to loosen tight or twisted tissues
Do not do Self Fertility Massage for at least 2-3 weeks after D&C or other abdominal procedure. Do not do this massage during bleeding after miscarriage or menses. The uterus may be sensitive and sore after any kind of surgical procedure, start off slowly and gently with this type of massage. Listen to your body, do not press too hard; you should not press so hard it is painful.
Castor Oil Pack
A Castor Oil Pack is a cloth soaked in castor oil, which is placed on the skin to enhance circulation, and promote healing of the tissues and organs underneath the skin. This therapy is complementary to Self Fertility Massage.
- Increases breakdown and removal of scar tissue build-up via the lymphatic system
- Increases circulation, brings in fresh healthy blood
- Promote new healthy tissue growth
- Aids the body of cleansing out old, dead, toxic, or damaged tissues
Castor oil packs are best used 2-3 times a week. A good healing plan with these packs are 3 days on, 3 days off, for several months. If you have had a surgical procedure, do not begin this until you feel your uterus is healed. Do not use on a C-section incision that is not fully healed.
Consider the Risk of Infection
Talk to your doctor about the risk of infection due to surgical procedures performed after miscarriage. If you develop an infection you risk more scar tissue and adhesion formation, as well as increased risk of infertility due to blocked fallopian tubes. Some herbs that help to aid the body in fighting infection and boosting immunity for proper immune response to the D&C would be Echinacea and Goldenseal. An Echinacea/Goldenseal liquid extract taken every 3 hours for the first two days after surgery may greatly help to reduce infection. This extract blend may be continued on 3 times a day, for a week as continued infection prevention.
Women’s Best Friend combines herbs shown to help fight infection and balance hormones after miscarriage loss. This herbal blend is extremely antibiotic, antimicrobial and anti-inflammatory. It works to heal any infection in the reproductive system, while also reducing pain and inflammation from foreign tissue growth. Reduction in inflammation may help to prevent scar tissue and adhesion. Some herbs in this blend are tonifying for the uterus, aiding in strengthening the uterine muscles and tissues. We do not recommend combining this herbal blend with medications prescribed by your doctor.
4. Hum. Reprod. (1998) 13 (12): 3347-3350.
5. Reproductive BioMedicine Online, (2011) Volume 23, Issue 1: 63-76.