Pregnancy Loss Pregnancy Loss Causes and Risk Factors Intrauterine Adhesions (Asherman Syndrome) The Role of D&Cs in Scarring of the Uterus By Krissi Danielsson Updated on May 03, 2020 Medically reviewed by Meredith Shur, MD Print Hero Images / Getty Images Intrauterine adhesions are areas of scar tissue on the walls of the uterus that usually develop after a woman has a dilation and curettage (D&C)—a procedure to clear the uterus of pregnancy tissue that wasn't expelled during a miscarriage. A study found that about one in five women develops scarring after a miscarriage. Less often, intrauterine adhesions result from an infection, such as genital tuberculosis (more common in developing countries than in the United States). Common Symptoms Linked to Intrauterine Adhesions Infertility Menstrual problems including amenorrhea (not having periods) Cyclic pelvic pain Recurrent pregnancy loss When intrauterine adhesions cause symptoms like these, a woman is said to have Asherman syndrome, which commonly occurs after a surgery like a D&C. There are a number of ways to detect scar tissue on the walls of the uterus, including hysteroscopy, hysterosonography, hysterosalpingogram, transvaginal ultrasound, or a combination. Each of these tests allows a doctor to actually see the adhesions. The most accurate is hysteroscopy, a procedure in which a thin, lighted tube is inserted into the vagina to examine the cervix and inside of the uterus. Treating Intrauterine Adhesions If you develop uterine scarring, your treatment will depend on the circumstances. For instance, if you don't plan to have children, there's no need to be treated surgically. The most common treatment for intrauterine adhesions is hysteroscopic resection, in which the scars are removed. Afterward, your doctor may recommend short-term placement of a Foley catheter to reduce the risk that the adhesions will return. You also may be given estrogen therapy to promote regrowth of the uterine tissue. If you've been trying unsuccessfully to conceive and it's suspected that scarring is the reason, you may be able to get pregnant after this procedure. Should a Woman Avoid a D&C After a Miscarriage? If you lose a pregnancy and your doctor advises you to have a D&C, you may worry that the procedure will leave behind scars and prevent you from getting pregnant again. Talk to your doctor and ask why they feel it's important to have the D&C. Be aware that most women do not develop significant adhesions after having one, and then weigh the risks and benefits with your caregiver. However, having multiple D&C procedures does appear to increase the risk of developing uterine adhesions, so you may want to avoid more than one D&C if it's not medically necessary. A Word From Verywell If you've been diagnosed with uterine scarring, you're clearly already regularly seeing and communicating with your doctor. Take the opportunity to raise any questions and concerns you have about receiving a D&C or other surgical procedure. If your doctor does advise you to have a D&C and it's clear that your health depends on it, you should at least get a second opinion before deciding to forgo it altogether. 3 Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hooker A, Lemmers M, Thurkow A, Heymans M, Opmeer B, Brölmann H, Mol B, Huirne J. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome. Hum Reprod Update. 2014;20(2):262-78. doi:10.1093/humupd/dmt045 Dreisler E, Kjer J. Asherman's syndrome: current perspectives on diagnosis and management. Int J Womens Health. 2019;11:191-198. doi:10.2147%2FIJWH.S165474 Conforti A, Alviggi C, Mollo A, De placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol. 2013;11:118. doi:10.1186%2F1477-7827-11-118 Additional Reading AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report: Practice guidelines for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):1-7. Cleveland Clinic. Hysteroscopy. July 18, 2018. Hooker AB et al. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, Risk factors, and long-term reproductive outcomes. Hum Reprod Update. 2014 Mar-Apr;20(2):262-78. Cedars, MI. (2016). Intrauterine Adhesions. In: UpToDate, Barbieri RL (Ed), UpToDate, Waltham, MA. By Krissi Danielsson Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Helpful Report an Error Other Submit