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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Gynecology

Treatment Strategy: Surgery and Preventing Recurrence

At a Glance

The standard treatment for Asherman syndrome is hysteroscopic adhesiolysis, using tiny scissors to remove uterine scar tissue. To prevent new scars from forming, doctors use physical barriers like balloon stents and often perform a series of staged surgeries to ensure the cavity heals properly.

Treating Asherman syndrome is a two-step challenge: first, the existing scar tissue must be removed, and second, the uterus must be prevented from “healing” itself by growing more scars [1][2]. Because the uterine walls naturally touch, they have a tendency to stick back together immediately after surgery, making the post-operative plan just as critical as the surgery itself [2].

The Standard: Hysteroscopic Adhesiolysis

The gold-standard treatment is hysteroscopic adhesiolysis [1]. During this procedure, the surgeon uses a hysteroscope (a camera) to look inside the uterus and carefully cut through the adhesions.

  • “Cold” Technique: Many specialists prefer using tiny micro-scissors or “cold” instruments rather than tools that use heat (electrosurgery). This helps avoid thermal injury, which can further damage the delicate foundation layer of the uterine lining [3].
  • Concurrent Ultrasound Guidance: Because dense scar tissue obscures the normal anatomy, many specialized surgeons use a live ultrasound on your abdomen while performing the hysteroscopy. This acts like a “GPS,” helping them navigate safely and greatly reducing the risk of accidentally poking through the uterine wall (perforation) [4][5].
  • The Danger of D&C: It is vital to know that a traditional dilation and curettage (D&C) should not be used to treat Asherman syndrome [6]. Because a D&C is performed “blindly,” it carries a high risk of scraping away healthy lining and creating even more scar tissue [7][8].

Preventing Recurrence

Once the scars are removed, the “raw” surfaces of the uterine walls are at high risk of sticking together again. To prevent this, doctors use adjuvant therapies—tools and treatments used alongside surgery:

Physical and Chemical Barriers

  • Balloon Stents: A small, specialized balloon is placed inside the uterus and inflated to act as a spacer, physically keeping the front and back walls from touching [9][2]. These may stay in place for several days to a week or more. While necessary, they can cause significant pelvic cramping or discomfort similar to a heavy period, and you may need over-the-counter pain medication while it is in place [10].
  • Hyaluronic Acid Gels: Surgeons may apply a thick, absorbable gel during the surgery. This creates a temporary biological film that reduces friction and helps lower the risk of new scars forming [11][12].
  • Silicone Sheets: In some cases, a thin, medical-grade silicone sheet is used to prevent the walls from fusing [13].

The Estrogen Debate

Many doctors prescribe high doses of estrogen after surgery to encourage the healthy parts of the uterine lining to regrow quickly and cover the “raw” spots [14]. However, this is a topic of active debate. While some studies suggest it helps improve pregnancy rates, others have found that high-dose estrogen might not be necessary for everyone, especially if effective physical barriers are used [15][16].

The “Staged” Approach

For patients with moderate to severe adhesions, one surgery may not be enough. The recurrence rate for severe cases can be significant, as the body’s inflammatory response may naturally try to close the cavity again [17][18].

  • Multiple Procedures: You may need a series of “staged” surgeries to gradually open the cavity without causing too much trauma at once [17][19].
  • Second-Look Hysteroscopy: Most specialists will schedule a quick “second-look” procedure a few weeks after the main surgery to ensure the cavity is staying open and to snip any tiny new adhesions before they become dense [20][21].

While severe cases are more complex, achieving a healthy, open cavity is the first major milestone in restoring your reproductive health [2][22].

Common questions in this guide

How is scar tissue from Asherman syndrome removed?
The gold-standard treatment is hysteroscopic adhesiolysis. A specialist uses a tiny camera called a hysteroscope and cold micro-scissors to carefully cut away the uterine scar tissue without using damaging heat.
Why should a D&C be avoided for treating Asherman syndrome?
A traditional dilation and curettage (D&C) is performed blindly without a camera. It carries a high risk of scraping away healthy uterine lining, which can create even more scar tissue and worsen the condition.
How do doctors prevent scars from returning after surgery?
Because the raw uterine walls naturally touch, they tend to stick together after surgery. Doctors use physical barriers like temporary balloon stents, hyaluronic acid gels, or silicone sheets to act as spacers while the uterus heals.
Will I need more than one surgery to treat Asherman syndrome?
Yes, patients with moderate to severe adhesions often need a staged approach. This means undergoing multiple surgeries or a quick second-look procedure a few weeks later to gradually clear the cavity and snip any new, early scars.
Why might I need to take estrogen after surgery?
Many specialists prescribe estrogen to encourage the healthy parts of the uterine lining to regrow quickly over the healing spots. However, the exact dosage and necessity of estrogen is currently a topic of debate among doctors.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Will you be using 'cold' instruments, like micro-scissors, to avoid heat damage to my remaining uterine lining?
  2. 2.Do you use concurrent ultrasound guidance during the surgery to prevent perforation?
  3. 3.Which specific physical and chemical barriers do you plan to use after the surgery?
  4. 4.What is your protocol for post-operative estrogen, and why do you recommend that specific dosage?
  5. 5.How many weeks will the balloon stent or other barrier remain in place, and what can I expect it to feel like?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (22)
  1. 1

    Results of centralized Asherman surgery, 2003-2013.

    Hanstede MM, van der Meij E, Goedemans L, Emanuel MH

    Fertility and sterility 2015; (104(6)):1561-8.e1.

    PMID: 26428306
  2. 2

    Long-term effects of hysteroscopic adhesiolysis on postoperative pregnancy rates and fertility outcomes in patients with intrauterine adhesions.

    Hu Y, Ma Y, Li W, Qu J

    American journal of translational research 2024; (16(10)):5605-5613 doi:10.62347/GRAK9062.

    PMID: 39544752
  3. 3

    Treatment Outcomes of Individualized PDLLA-Copper Stents Versus Intrauterine Balloons in Moderate-to-Severe Intrauterine Adhesions After Hysteroscopic Adhesiolysis: A Propensity Score-Weighted Analysis.

    Zhao K, Tang S, Zhang F, et al.

    Journal of minimally invasive gynecology 2026; doi:10.1016/j.jmig.2026.01.010.

    PMID: 41521000
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    Value of 2D ultrasonography in the diagnosis and evaluation of intrauterine adhesions - a prospective study.

    Huang R, Huang X, Li S, et al.

    Reproductive biomedicine online 2024; (49(2)):103771 doi:10.1016/j.rbmo.2023.103771.

    PMID: 38761561
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    Comparative Analysis of Hysterosalpingography and Diagnostic Hysteroscopy Findings in Infertility Evaluation.

    G M, M S

    Cureus 2025; (17(4)):e81789 doi:10.7759/cureus.81789.

    PMID: 40330349
  6. 6

    Identifying the risk factors and incidence of Asherman Syndrome in women with post-abortion uterine curettage.

    Sevinç F, Oskovi-Kaplan ZA, Çelen Ş, et al.

    The journal of obstetrics and gynaecology research 2021; (47(4)):1549-1555 doi:10.1111/jog.14667.

    PMID: 33462894
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    Intrauterine Adhesions Following Miscarriage: Look and Learn.

    Gilman AR, Dewar KM, Rhone SA, Fluker MR

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2016; (38(5)):453-7.

    PMID: 27261221
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    Prevalence and risk factors of intrauterine adhesions in women with a septate uterus: a retrospective cohort study.

    Shen M, Duan H, Chang Y, Lin Q

    Reproductive biomedicine online 2022; (44(5)):881-887 doi:10.1016/j.rbmo.2022.02.004.

    PMID: 35361544
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    Post-hysteroscopy Duration of the Cook Balloon Uterine Stent Effect on the Re-adhesion Formation.

    Qu S, Zhou P

    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2021; (31(10)):1163-1167 doi:10.29271/jcpsp.2021.10.1163.

    PMID: 34601835
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    Extended intrauterine balloon stent use to prevent adhesion reformation after hysteroscopic adhesiolysis: a randomized trial.

    Luo Y, Liu Y, Xiao Y, et al.

    Fertility and sterility 2025; (124(1)):144-152 doi:10.1016/j.fertnstert.2025.01.024.

    PMID: 39884334
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    Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage.

    Fei Z, Xin X, Fei H, Yuechong C

    European journal of obstetrics, gynecology, and reproductive biology 2020; (244()):1-4 doi:10.1016/j.ejogrb.2019.10.018.

    PMID: 31731019
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    Meta-analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations.

    Zheng F, Xin X, He F, et al.

    Experimental and therapeutic medicine 2020; (19(4)):2672-2678 doi:10.3892/etm.2020.8483.

    PMID: 32256748
  13. 13

    Efficacy of silicone sheet as a personalized barrier for preventing adhesion reformation after hysteroscopic adhesiolysis of intrauterine adhesions.

    Azumaguchi A, Henmi H, Saito T

    Reproductive medicine and biology 2019; (18(4)):378-383 doi:10.1002/rmb2.12294.

    PMID: 31607798
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    Efficacy of high-dose estrogen and progesterone sequential assisted hysteroscopic cold knife separation versus hysteroscopic cold knife separation alone in the treatment of infertility or amenorrhea caused by severe intrauterine adhesion: a retrospective cohort study.

    Wang X, Han J, Song Y

    BMC surgery 2025; (25(1)):246 doi:10.1186/s12893-025-02964-z.

    PMID: 40474175
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    A prospective, randomized, controlled trial comparing two doses of oestrogen therapy after hysteroscopic adhesiolysis to prevent intrauterine adhesion recurrence.

    Guo J, Li TC, Liu Y, et al.

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    PMID: 28784336
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    Estrogen therapy before hysteroscopic adhesiolysis improves the fertility outcome in patients with intrauterine adhesions.

    Zhang L, Wang M, Zhang Q, et al.

    Archives of gynecology and obstetrics 2019; (300(4)):933-939 doi:10.1007/s00404-019-05249-y.

    PMID: 31350664
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    Effect of hysteroscopic adhesiolysis on recurrence, menstruation and pregnancy outcomes in patients with different degrees of intrauterine adhesions.

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    American journal of translational research 2022; (14(1)):484-490.

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    Hysteroscopic adhesiolysis: efficacy and safety.

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This page provides educational information about surgical treatments for Asherman syndrome. Always consult with a specialized gynecologist or reproductive endocrinologist to determine the safest and most effective approach for your specific case.

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