Asherman’s Syndrome (Scar Tissue Inside the Womb): Causes, Treatment and Pregnancy

In short

Asherman’s syndrome means scar tissue (adhesions) inside the womb, usually after the lining has been injured, most often by a curettage after a miscarriage or after delivery. It can make periods very light or stop them, and it can affect fertility and pregnancy. Hysteroscopy both confirms it and treats it, by carefully dividing the scar tissue while protecting the healthy lining. Many women conceive after treatment; the outlook depends mainly on how extensive the scarring was and how well the lining recovers.

What is Asherman’s syndrome?

The inner lining of the womb (endometrium) has a deep base layer that regrows the lining each month. If this base layer is injured, the walls of the womb can heal stuck to each other, forming bands of scar tissue. These are called intrauterine adhesions. When they cause symptoms such as reduced periods, infertility or pregnancy loss, the condition is called Asherman’s syndrome.

Why it happens

• Curettage of the pregnant womb, after a miscarriage, after delivery for retained tissue, or for bleeding after childbirth. This is the most common cause, and the risk rises with repeated procedures.
• Other surgery inside the womb, such as removal of fibroids that enter the cavity.
• Infection of the lining, including genital tuberculosis, which remains an important cause in India.

It is a known risk of procedures that are often necessary, and nothing a woman caused herself.

Symptoms

• Periods that became much lighter, or stopped, after a procedure on the womb
• Cyclical lower abdominal pain without bleeding, when blood is trapped behind scar tissue
• Difficulty conceiving
• Repeated miscarriage

Mild adhesions may cause no symptoms and are sometimes found only during fertility tests.

How it is diagnosed

A detailed transvaginal ultrasound, sometimes a 3D scan or saline sonography, can suggest adhesions and show how thick the lining is. Hysteroscopy, a thin telescope passed through the cervix, is the most accurate test: it shows where the scar tissue is, how dense it is and how much healthy lining remains. International guidance (AAGL with ESGE, 2017) recommends hysteroscopy for diagnosis and for grading severity, because the grade guides treatment and counselling.

Treatment: hysteroscopic adhesiolysis

Treatment is by operative hysteroscopy. Under direct vision, the surgeon divides the scar tissue with fine instruments to restore the normal shape of the cavity, taking care to preserve as much healthy lining as possible. Gentle, precise technique matters more than speed here, because the aim is a healthy lining, not only an open cavity.

• There is no cut on the abdomen, and most women go home the same day.
• Mild adhesions are often treated in one sitting. Dense or extensive scarring may need more than one procedure.
• A second-look hysteroscopy a few weeks later is often advised, to check that adhesions have not re-formed and to treat any early ones while they are still soft.

Read more on our hysteroscopy page.

Stopping the scar tissue from coming back

Adhesions can re-form after treatment. Several measures are used to reduce this: a temporary balloon or device in the cavity, oestrogen to help the lining regrow, and barrier gels. A Cochrane review found fewer adhesions at second-look hysteroscopy with these measures, but the quality of the evidence was low, and none has been proven to increase live births (Bosteels 2017). The choice is therefore individualised, based on how severe the scarring was.

Fertility and pregnancy after treatment

Many women conceive after treatment. The chances are best when the scarring was mild and the lining regrows well, and lower when the scarring was severe. If the lining remains thin despite treatment, your doctor will discuss the next steps, which may include IVF with careful preparation of the lining.

A pregnancy after Asherman’s syndrome needs closer monitoring. Guidance notes higher risks of miscarriage, preterm birth and problems with how the placenta attaches. These are planned for in advance with your obstetric team, so that the pregnancy and delivery are managed with care.

Can it be prevented?

Risk is reduced by gentle technique whenever the pregnant womb needs to be emptied, by considering medical management of miscarriage where it is suitable, and by avoiding repeated curettage when it is not essential. If your periods change markedly after any procedure on the womb, mention it to your doctor early.

When to see a gynaecologist

See a doctor if your periods have become very light or stopped after a D&C or delivery, if you have cyclical pain without bleeding, or if you are finding it difficult to conceive after a previous procedure on the womb. Bring your earlier operation notes and scan reports. Book a consultation.

Frequently asked questions

What causes Asherman’s syndrome?
Most often, injury to the deep layer of the womb’s lining during a curettage after miscarriage or delivery. Other surgery inside the womb and infections, including genital tuberculosis, are other causes.

Can I get pregnant with Asherman’s syndrome?
Many women conceive after treatment. The chances depend mainly on how severe the scarring was and how well the lining regrows.

How is Asherman’s syndrome treated?
By hysteroscopy, dividing the scar tissue under direct vision while protecting the healthy lining. Severe scarring may need more than one procedure, and a second-look hysteroscopy is often advised.

Can the adhesions come back after treatment?
Yes, they can re-form. Measures such as a temporary balloon, oestrogen or gels reduce adhesions on a second look, but evidence that they improve birth rates is limited, so the choice is individualised.

Is pregnancy after Asherman’s syndrome high risk?
It needs closer monitoring, because the risks of miscarriage, preterm birth and placental problems are higher. These are planned for in advance with your obstetric team.

Sources and further reading

• AAGL, in collaboration with ESGE. Practice guidelines on intrauterine adhesions. J Minim Invasive Gynecol. 2017;24(5):695–705. doi:10.1016/j.jmig.2016.11.008
• Bosteels J, et al. Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility. Cochrane Database Syst Rev. 2017;11:CD011110. doi:10.1002/14651858.CD011110.pub3

General education, not personal medical advice. Last reviewed: October 2026.