Uterine scar tissue, also known as intrauterine adhesions, can be caused by a number of factors. Uterine scarring can be the result of trauma and the natural healing process. Surgery, dilation and curettage (D&C) procedures, and aggressive infection are also common causes.
The endometrium is the term used for the uterine lining. It is made up of two layers. The functional layer is the upper portion of the endometrium that is shed during the menstrual cycle, and the basal layer is below the functional layer. The scar tissue of the uterus is found in this lower layer.
When surgery is the cause of intrauterine adhesions, it is often associated with a cesarean section or a procedure to remove fibroid tumors. Fibrosis is the condition where the uterine muscle develops non-cancerous tumors. These tumors are removed if they are abnormally large or impair fertility.
Procedures D and C are often done after a miscarriage. During this procedure, the cervix is dilated and the uterine lining is scraped away. Because of how this procedure is done, it is common to develop scar tissue from the uterus.
If serious infections occur in the uterus, the lining and wall of the uterus can be damaged. Minor infections do not usually cause damage to the uterus, but some infections, such as those caused by sexually transmitted diseases, can cause scarring. In some cases, bladder or urinary tract infections can spread to the vagina and uterus. Other vaginal infections can also spread from the vagina to the uterus if left untreated.
Asherman syndrome (AS) is a condition that coincides with the presence of intrauterine adhesions. A woman with Asherman's syndrome may have fibrous tissue in addition to the scars. The imaging results of a sonohysterogram can detect the presence and extent of uterine scarring.
Treatment of scar tissue in the uterus is an option when the scars cause problems such as infertility, pain, or abnormal bleeding. Removal of scar tissue is possible with an operative hysteroscopy. This procedure involves a thin telescope with special attachments to carefully remove scar tissue.
Medications may be prescribed that help prevent scar tissue in the uterus from coming back. Sequential hormone therapy of estrogen followed by progestin is often prescribed. These medications trigger the growth of the endometrium. In addition to medication in some cases, gel or mechanical barriers, such as stents, are used to prevent opposing walls from fusing together.