Asherman's Syndrome: When Uterine Scarring Stops Pregnancy (Causes, Diagnosis, Treatment)
November 7, 2026
Cloudnine
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Asherman's Syndrome: When Uterine Scarring Stops Pregnancy (Causes, Diagnosis, Treatment)
November 7, 2026
Cloudnine
No items found.
Asherman syndrome is scar tissue inside the uterus, usually after a D&C for miscarriage or after delivery. It can make periods very light or stop them, and can cause infertility or repeated miscarriage. Hysteroscopy confirms it and treats it in the same sitting, and many women conceive afterwards, especially when scarring is mild.
What is Asherman's S
yndrome?
Asherman's syndrome is scar tissue, called intrauterine adhesions, uterine adhesions, or uterine synechiae, inside the uterus. The scars form when the deepest layer of the lining is injured, and the front and back walls may fuse, either partially or completely. It is also called Fritsch Asherman syndrome. Not everyone with adhesions has symptoms; doctors use the term "syndrome" when the scarring causes period changes, pain, or fertility problems.
Table 1. Asherman's syndrome at a glance
A quick summary of the figures this guide explains, each with its source.
How common after miscarriage?
About 1 in 5 women who are checked within a year of a miscarriage have some adhesions
Most common cause
D&C after miscarriage, abortion or delivery
Most accurate test
Hysteroscopy
Main treatment
Hysteroscopic removal of the scar tissue
Chance of scars returning
30 to 66 percent, higher when scarring is severe
Pregnancy after treatment
About 51 percent overall, much lower in severe cases
How Does Uterine Scarring After a D&C Develop?
The uterus lining has a deep basal layer that regrows a fresh lining every month. A D&C done soon after a miscarriage or delivery, when the uterus is soft and the lining is fragile, can scrape into that basal layer. Where it is damaged, the raw walls can knit together instead of regrowing a lining.
Repeat procedures matter more than one. In a review of 912 women checked by hysteroscopy within a year of miscarriage, 19.1% had adhesions, and the number of D&Cs was the main driver of risk. Most were mild: 58% mild, 28% moderate, and 14% severe. That is one reason doctors now consider medicines or a gentle suction procedure, rather than repeated scraping, when a miscarriage needs help to complete.
Uterine scarring after D&C usually shows up in the first cycles after the procedure. Periods that come back much lighter, or not at all, signal that you should get checked rather than wait. If you have had more than one loss, our guide to recurrent miscarriage causes, tests and treatment explains the wider workup.
Asherman Syndrome Symptoms and Diagnosis
What are the symptoms of uterine scarring after a D&C?
The main symptom of uterine scarring after a D&C is periods that become much lighter than before, or stop completely, even though you still feel the usual monthly signs. Some women have cramps with little or no bleeding. Others notice nothing until they struggle to conceive or miscarry again.
● Much lighter periods (hypomenorrhoea). The most common pattern, seen in 53% of women in an Indian hospital study.
● No periods (amenorrhoea). Often with normal hormone tests, which points to the uterus rather than the ovaries.
● Cyclical pain with little bleeding. Blood trapped behind scar tissue can cause monthly cramps.
● Difficulty conceiving. Scar tissue leaves less healthy lining for an embryo to implant.
● Repeated miscarriage or failed IVF transfers. The damaged lining struggles to support a pregnancy.
● No symptoms at all. Some women only find out during fertility tests.
Light or missed periods have other causes too, such as thyroid problems, high prolactin or pregnancy, so your doctor will check hormones before blaming scarring.
How do I tell if I have Asherman's syndrome?
You can only tell for certain by looking inside the uterine cavity. Your doctor starts with your history (a recent D&C, light periods) and a vaginal scan, then confirms with a test that fills or views the cavity. Hysteroscopy is the most accurate, because a thin camera shows the scars directly.
Table 2. Tests for Asherman's syndrome and how well they pick it up
Accuracy figures are from the AAGL and ESGE practice guideline. Sensitivity is the share of women with adhesions that the test correctly detects.
Transvaginal ultrasound (2D)
Shows a thin or patchy lining
Low, about 52 percent sensitivity; a normal scan does not rule it out
3D ultrasound
Builds a picture of the cavity shape
About 87 percent sensitivity in one study, measured against 3D sonohysterography rather than hysteroscopy
Doctors grade the scarring because severity predicts how well treatment works. Several systems exist, including the American Fertility Society score of 1988, which combines how much of the cavity is blocked, how dense the scars are, and your period pattern. No single system is agreed worldwide.
Table 3. A simple guide to Asherman's syndrome severity
Cavity extent follows the March classification; pregnancy rates come from an Indian cohort of 60 women treated with hysteroscopy.
Mild
Thin, filmy bands over less than a quarter of the cavity
Normal or slightly lighter
53.3%
Moderate
Adhesions over a quarter to three quarters of the cavity, walls not fused
Lighter
26.9%
Severe
More than three quarters involved, walls stuck together, tube openings often blocked
Very light or absent
9.5%
Asherman Syndrome Causes: What Leads to Uterine Scarring?
Most cases follow injury to the lining during a procedure on a pregnant or recently pregnant uterus. In about half the women in one Indian series, no clear cause was found at all.
● D&C after miscarriage or abortion. The most common cause, with risk rising with each repeat procedure.
● Procedures after delivery. Removing retained placenta or treating heavy bleeding after childbirth.
● Uterine surgery. Removal of fibroids from inside the cavity, caesarean section, and other operative hysteroscopy.
● Genital tuberculosis. Still important in India; TB involves the uterine lining in 50 to 80% of women with genital TB and can leave dense, hard-to-treat scars.
● Infection of the lining (endometritis). Infection may play a part, though the evidence is limited.
● Endometrial ablation. A procedure that deliberately destroys the lining to reduce bleeding.
How is Asherman's Syndrome Treated?
Operative hysteroscopy to remove the scar tissue
Asherman's syndrome is treated with operative hysteroscopy, called Hysteroscopic Adhesiolysis. A thin telescope is passed through the cervix, and fine scissors or energy instruments cut the scars under direct vision, restoring the shape of the cavity. It is usually a day care procedure under anaesthesia. Do not use blind D&C to treat adhesions, as it can deepen the injury.
1. Assessment: Scan, hormone tests, and, if TB is suspected, an endometrial biopsy.
2. Adhesiolysis: Scar tissue is divided under direct vision, sometimes with ultrasound guidance in severe cases.
3. Barrier placement: A balloon, catheter or gel keeps the walls apart while they heal.
4. Hormone support: Estrogen, sometimes followed by progestogen, helps the lining regrow.
5. Second look: Repeat hysteroscopy after two to three cycles checks for new scars.
Severe cases often need more than one operation. In the Indian study, 63% of women needed a second-look hysteroscopy. Our article on hysteroscopy for fertility in India explains what to expect on the day.
Preventing scar tissue from coming back
Adhesions return in 30 to 66% of women after surgery, about one in three with mild to moderate disease and two in three with severe disease. The steps below lower that risk, and the guideline grades the evidence for each.
Table 4. Ways to reduce recurrence after adhesiolysis
Evidence grades are from the AAGL and ESGE guideline; Grade A is the strongest.
Balloon, catheter or inert IUD
Physically keeps the walls apart while they heal
Grade A for fewer new adhesions
Hyaluronic acid gel
Coats the raw surfaces after surgery
Grade A for fewer new adhesions; effect on pregnancy unknown
Estrogen with or without progestogen
Helps the lining regrow
Grade B
Second look hysteroscopy
Finds and divides early new scars
Recommended after two to three cycles
Stem cells, aspirin, sildenafil or nitroglycerin
Experimental attempts to regrow lining
Not recommended outside research (Grade C)
Be cautious with clinics offering stem cell "cures". The guideline is clear that stem cell therapy is promising but not ready for routine use.
How Much Does Asherman Syndrome Treatment Cost in India?
Asherman's syndrome diagnosis and treatment in India usually costs from a few thousand rupees for scans to tens of thousands for hysteroscopy, depending on how severe the scarring is and how many procedures you need. The table lists every test and procedure in this guide.
Table 5. Asherman's syndrome tests and treatment: indicative costs at Cloudnine Fertility
These ranges are indicative figures supplied by Cloudnine Fertility and have not yet been confirmed against the audited price sheet. Final cost depends on city, anaesthesia, day care versus admission, and whether a balloon, gel or repeat surgery is needed.
Thyroid (TSH) and prolactin tests, to rule out hormonal causes of light periods
₹ 400 to ₹ 1,200
When should you see a Doctor?
See a gynaecologist if your periods are much lighter or missing two to three cycles after a D&C or delivery, or if you are not conceiving after any uterine procedure. Earlier treatment means less dense scarring to deal with.
Table 6. Signs that need a check, and how soon
Symptoms are those described by ASRM; the timings are practical advice from Cloudnine Fertility specialists, not guideline cutoffs.
Fever, foul-smelling discharge or worsening pain after a recent D&C
Same day
Monthly cramps with little or no bleeding after a procedure
Within two weeks
Periods much lighter or absent for two cycles after a D&C or delivery
Within a month
Two or more miscarriages, or repeated failed embryo transfers
Book a fertility review
Planning pregnancy after previous Asherman's treatment
Before you start trying
If any of these sound familiar, a Cloudnine Fertility specialist can look at your history and arrange the right test first. Book a consultation.
Can I Get Pregnant with Asherman's Syndrome?
Yes, many women get pregnant after treatment for Asherman's syndrome, but the chance depends on how severe the scarring was. A review of 54 studies and 4,640 women found an overall pregnancy rate of about 51% after hysteroscopic treatment. ASRM reports full-term pregnancy rates of about 70 to 80% for mild to moderate adhesions and 20 to 40% for severe cases.
Table 7. What to expect in pregnancy after Asherman's treatment
Pooled figures from the 2019 systematic review. These describe groups of women, not your personal chance
Pregnancy
50.7%
Early pregnancy loss
17.7%
Ectopic pregnancy
4.2%
Mid trimester loss
11.5%
Placenta accreta (placenta grows too deeply)
10.1%
Because of the placenta accreta and preterm risks, pregnancy after Asherman's should be booked early with an obstetric team that knows your history. If the lining does not recover after repeated treatment, IVF with a gestational carrier is the remaining option. Our overview of fertility treatments for uterine related infertility compares the paths.
FAQs
Your questions, clearly answered
Find clear, trusted answers to the most common questions about IVF—designed to guide and support you every step of the way.
How serious is Asherman's syndrome?
Asherman's syndrome is not life-threatening, but it can be serious for fertility. Mild scarring often responds well to a single hysteroscopy. Severe scarring, where the walls are fused and the lining is thin, may need several operations and still lower the chance of pregnancy. Pregnancies after treatment also carry higher risks, including placenta accreta.
Can you cure Asherman's syndrome?
Asherman's syndrome can often be treated successfully, but cure depends on severity. Hysteroscopic removal of scar tissue restores normal periods in many women. Scars recur in 30 to 66% of cases, so doctors usually plan a second hysteroscopy. Severe scarring with little healthy lining left is the hardest to treat.
Can Asherman's syndrome be seen on an ultrasound?
A routine 2D ultrasound often misses Asherman's syndrome, detecting only about half of cases, so a normal scan does not rule it out. A 3D scan or saline sonohysterogram detects more cases. Hysteroscopy remains the only test that confirms the diagnosis and lets your doctor treat it in the same procedure.
Can I get Asherman's syndrome after one D&C?
Yes, Asherman's syndrome can develop after a single D&C, though the risk rises with each repeat procedure. About one in five women checked after a miscarriage had adhesions. Most were mild. If your periods become much lighter or stop after a D&C, get checked rather than waiting.
How can I prevent Asherman's syndrome after a miscarriage?
Ask whether medicines or simply waiting are suitable before agreeing to a D&C. The number of D&Cs drives risk. If a procedure is needed, gentle suction under ultrasound guidance is preferred over repeated scraping. Afterwards, report much lighter or absent periods promptly, because early, mild adhesions are the easiest to treat.
Can uterine scar tissue heal naturally?
Intrauterine scar tissue does not dissolve with diet, herbs, yoga or massage. Some women with mild scarring do conceive without surgery, but this can take a long time. If your periods have changed after a procedure, or you are not conceiving, hysteroscopy is the only way to remove scars and restore the cavity.
How long does recovery take after hysteroscopic adhesiolysis?
Most women go home the same day and can resume normal activity within a few days. Light bleeding and cramps for some days are common. Your doctor will usually prescribe hormone support and plan a check hysteroscopy after two to three cycles before you try to conceive.
Can I do IVF if I have Asherman's syndrome?
Yes, IVF is possible after Asherman's syndrome, but the scarring must be treated first and the lining checked. An embryo cannot implant well on scar tissue, so your fertility team will confirm a healthy cavity and adequate lining thickness before embryo transfer. Asherman's is one cause doctors look for after repeated failed transfers.
Light or missing periods after a D&C are worth discussing, not waiting out. Cloudnine Fertility specialists can confirm what is going on, explain your options honestly, and plan treatment around your fertility goals. Book a consultation.
