Laura Douglas is a First5 Salaried GP in York
So have you heard of Asherman’s Syndrome? Like me, this may stir up some distant memory in the back of your mind from a lecture sometime at medical school. But that’s probably it. Certainly this was my experience, until I was diagnosed with it. Asherman’s is characterised by adhesions in the uterus typically caused through trauma to the basal layer of the endometrium through curettage of a pregnant uterus.1,2 This means that it often occurs, like in my case, following surgical management of a miscarriage. The resultant effects, are reduced or absent menstruation. Why then, if 1 in 4 pregnancies result in miscarriage in the UK3, are we not more familiar with this term? I suspect it is because typically, it is only discovered through the long road of fertility investigations occurring away from primary care.
…it is often their GP that they consult with first, asking: why are my periods lighter since my miscarriage? why have my periods stopped?
Through my own personal exploration of this condition, I discovered that many primary care colleagues like myself, were unaware of this as a diagnosis and its presentation. Yet, from speaking to other women with this condition, I have learnt that it is often their GP that they consult with first, asking: why are my periods lighter since my miscarriage? why have my periods stopped? Could something be wrong, as I am not getting pregnant again? … Often women would wait months before seeking help, and unfortunately, many women are told like myself, to wait and see; it can be normal for periods to be reduced following a pregnancy. I unfortunately learnt, that this is not strictly true, and waiting just allowed more time for the adhesions to worsen.
The gold standard for diagnosis is a hysteroscopy.1,2 We therefore cannot make this diagnosis as a GP, but we can be listening out for these women’s concerns and referring to secondary care sooner for investigation. Early identification allows for earlier management to remove adhesions. This crucially will help women in future pregnancies, trying to conceive, and reduce adhesions from worsening further.2 Following a miscarriage, the heartbreak is very real, and for many women there is a strong desire to try again and have that much wanted child.4 Asherman’s can stop that from happening, and understanding women’s concerns, and listening to their symptoms, can hopefully help them to achieve their dream of carrying their own child in the future.
1. Heinonen PK. Kohtukiinnikkeet ja Ashermanin oireyhtymä [Intrauterine adhesions–Asherman’s syndrome]. Duodecim. 2010;126(21):2486-91. Finnish. PMID: 21171473.
2. Dreisler E, Kjer JJ. Asherman’s syndrome: current perspectives on diagnosis and management. Int J Womens Health. 2019 Mar 20;11:191-198. doi: 10.2147/IJWH.S165474. PsMID: 30936754; PMCID: PMC6430995.
3. Tommy’s. Miscarriage Statistics [internet]. 2020 [cited 2023 March 20]. Available from: www.tommys.org/baby-loss-support/miscarriage-information-and-support/miscarriage-statistics
4. Tommy’s. Trying again after Miscarriage [internet]. 2020 [cited 2023 March 20]. Available from: www.tommys.org/baby-loss-support/miscarriage-information-and-support/trying-again-after-miscarriage