Intrauterine adhesions are bands of scar tissue inside the uterine cavity. They are also called intrauterine synechiae, and when they are associated with menstrual, pain or fertility problems the condition is commonly called Asherman syndrome. They are different from pelvic adhesions around the uterus, ovaries or fallopian tubes.
You may have no symptoms, or notice periods becoming much lighter or stopping, cyclic pain, difficulty becoming pregnant or recurrent miscarriage. A routine pelvic ultrasound can be normal even when adhesions are present. When the history raises enough concern, hysteroscopy provides the most direct and accurate assessment of the uterine cavity.
Quick answers about intrauterine adhesions
What are intrauterine adhesions?
Intrauterine adhesions are bands of scar tissue that partly join surfaces inside the uterine cavity. They are sometimes called uterine synechiae. When they cause menstrual, pain or fertility problems, the condition is commonly called Asherman syndrome.
Can a normal ultrasound rule out intrauterine adhesions?
No. A routine pelvic ultrasound may not show thin or localised adhesions. Saline sonography or HSG can provide more information about the cavity, while hysteroscopy is the most accurate test because the inside of the uterus is viewed directly.
When should you ask for specialist review?
Ask about gynaecology or fertility review if periods become markedly lighter or stop after uterine treatment, you have cyclic pain with little bleeding, recurrent miscarriage, difficulty conceiving or an abnormal cavity test. Seek urgent care for severe pain, heavy bleeding, fever, fainting or sudden deterioration.
Why does the location of an adhesion matter?
The word “adhesion” describes scar tissue that can occur in several places. For fertility and treatment decisions, where the scar tissue is located matters more than the word adhesion itself.
| Location | What may be affected | How it may be assessed |
|---|---|---|
| Inside the uterine cavity | Menstrual flow, cavity shape, implantation and future pregnancy | Hysteroscopy, saline sonography or HSG |
| Around the fallopian tubes or ovaries | Tubal movement, egg pickup, fertility and sometimes pain | Tubal imaging and, in selected cases, laparoscopy with dye |
| Elsewhere in the pelvis or abdomen | Movement-related pain or bowel, bladder and pelvic symptoms | Assessment directed by symptoms, history and the suspected condition |
Hysteroscopy assesses the inside of the uterus. It does not map adhesions around the ovaries, bowel or outer surface of the uterus. Conversely, laparoscopy does not replace careful assessment of the uterine cavity when intrauterine adhesions are suspected.
If pelvic pain is the main concern rather than a menstrual change after uterine treatment, the causes may be broader. The guide to endometriosis and ovulation-related pelvic pain covers a different set of possible causes.
Which history makes intrauterine adhesions more likely?
Intrauterine adhesions form after damage and inflammation affect the endometrium, the lining of the uterine cavity. They are particularly associated with uterine procedures performed during or after pregnancy, although most people who need these procedures do not develop Asherman syndrome.
Relevant histories include:
- Dilation and curettage after miscarriage, retained pregnancy tissue or birth
- More than one uterine evacuation or curettage procedure
- Retained placenta or postpartum haemorrhage requiring uterine treatment
- Infection involving the uterus around childbirth, miscarriage or surgery
- Hysteroscopic surgery for fibroids, polyps, a uterine septum or other cavity lesions
- Other uterine surgery or instrumentation
- Rarely, intrauterine adhesions without an obvious preceding event
The history raises or lowers suspicion; it does not establish the diagnosis. If you recently had uterine treatment after pregnancy loss, the guide to trying to conceive after a D&C explains routine recovery separately from symptoms that deserve further assessment.
Which symptoms can intrauterine adhesions cause?
Some intrauterine adhesions cause no noticeable symptoms. Others change menstrual flow or interfere with the uterine cavity enough to affect fertility or pregnancy.
Possible symptoms and clinical clues include:
- Periods that become substantially lighter after a uterine procedure
- Periods stopping when they had previously been present
- Cyclic pelvic pain with very little or no menstrual bleeding
- Difficulty becoming pregnant
- Repeated pregnancy loss
- Difficulty with embryo transfer or repeated concerns about the uterine cavity
These symptoms are not specific to Asherman syndrome. Lighter or absent periods can also occur because of pregnancy, hormonal contraception, thyroid conditions, hypothalamic causes, reduced oestrogen, perimenopause and other endocrine problems. Pelvic pain can have ovarian, endometriosis, adenomyosis, bowel, bladder and musculoskeletal causes.
If the main issue is difficulty conceiving, it is therefore important not to assume that the cavity is the only factor. A broader female fertility assessment may need to consider ovulation, tubes, age-related factors and other diagnoses as well.
Can you still have periods if you have Asherman syndrome?
Yes. The menstrual pattern depends partly on the location and extent of the adhesions. Extensive scar tissue may be associated with absent or markedly reduced bleeding, while small or localised adhesions may leave menstrual flow relatively unchanged.
This is why neither a normal-looking period nor a light period can diagnose or exclude the condition on its own. What matters is the combination of your previous pattern, any uterine procedure or pregnancy complication, current symptoms and the findings from appropriate cavity assessment.
Does the severity of intrauterine adhesions change treatment?
Yes. Intrauterine adhesions can range from small, thin or filmy bands to denser and more extensive scar tissue that partly or substantially distorts the cavity. Different classification systems are used in clinical practice, but a stage number by itself does not tell you your personal fertility outcome.
Severity matters because more extensive disease can make hysteroscopic treatment technically more difficult, may require more than one procedure and is associated with a greater risk of the adhesions reforming. The amount of healthy endometrium that remains, menstrual pattern, fertility goals and previous treatment also influence management.
Small incidental adhesions do not automatically need surgery. If they are not causing symptoms and pregnancy is not planned, observation may sometimes be appropriate after discussion with the treating clinician.
Which tests are used for intrauterine adhesions?
The appropriate test depends on the history, symptoms and what the clinician needs to establish. No single home symptom or blood test diagnoses intrauterine adhesions.
| Test | What it can show | Important limitation |
|---|---|---|
| Routine pelvic ultrasound | Uterine shape, endometrium, fibroids, polyps and other pelvic findings | Thin or localised adhesions may not be visible |
| Saline infusion sonography | Fluid outlines the uterine cavity and can make irregularities easier to see | It is still an indirect cavity assessment |
| Hysterosalpingography (HSG) | Contrast outlines the uterine cavity and fallopian tubes | Filling defects can suggest adhesions but the scar tissue is not viewed directly |
| Hysteroscopy | Direct view of the uterine cavity and scar tissue | It is an invasive procedure and treatment planning depends on complexity and setting |
| MRI | May answer a separate complex pelvic question | Not a routine first-line diagnostic test for intrauterine adhesions |
Why can a routine ultrasound miss adhesions?
A standard pelvic ultrasound is useful for many gynaecological conditions, but subtle bands of scar tissue can be difficult to distinguish. A normal ultrasound therefore lowers concern for some structural problems but does not reliably exclude intrauterine adhesions when the history remains strongly suggestive.
What is saline sonography?
During saline infusion sonography, sterile fluid is placed into the uterine cavity while ultrasound is performed. The fluid separates the cavity walls and can make focal adhesions or other abnormalities easier to identify.
What can an HSG show?
Hysterosalpingography uses contrast and X-ray to outline the cavity and fallopian tubes. It may reveal filling defects or areas where the cavity does not open normally. It can also provide information about tubal patency, but abnormal findings may need clarification because HSG does not directly visualise the scar tissue.
Why is hysteroscopy the most accurate test?
Hysteroscopy allows the clinician to see the uterine cavity directly through a thin telescope passed through the cervix. It can show the location, density and extent of adhesions and, where appropriate, treatment may be performed hysteroscopically during the same or a planned procedure.
When is hysteroscopic treatment considered?
When clinically significant intrauterine adhesions are causing symptoms, infertility or another important cavity problem, treatment is generally performed hysteroscopically under direct vision. The aim is to divide the scar tissue, restore the cavity where possible and minimise additional injury to healthy endometrium.
Dense or extensive adhesions may require an experienced hysteroscopic surgeon and sometimes more than one procedure. Treatment decisions take into account:
- Location and extent of the adhesions
- Menstrual symptoms
- Fertility and pregnancy goals
- Previous treatment and recurrence
- Whether the cervix or tubal openings are involved
- How much healthy endometrium appears to remain
- The expertise and equipment needed for the procedure
A blind D&C is not the preferred treatment for intrauterine adhesions. Without direct visualisation, the operator cannot precisely distinguish the scar tissue from healthy cavity surfaces, and further endometrial injury is possible.
Why does follow-up matter after adhesiolysis?
Intrauterine adhesions can reform after hysteroscopic treatment, particularly when the original disease was dense or extensive. That is why the treatment plan often continues beyond the first procedure.
Depending on the individual situation, a clinician may discuss a temporary intrauterine balloon or catheter, another mechanical barrier, hyaluronic-acid-based products or hormone treatment intended to support endometrial recovery. Evidence suggests some approaches can reduce adhesion formation or improve cavity scores, but this should not be converted into a promise of a higher pregnancy or live-birth rate.
A 2026 Australian study of women treated for Asherman syndrome found no clear difference in repeat surgery, pregnancy or obstetric outcomes between hysteroscopic adhesiolysis with hyaluronic acid and surgery alone in the study population. The study was relatively small, so it adds useful Australian evidence without establishing that one post-operative strategy is best for everyone.
Follow-up may include another hysteroscopy, saline sonography or another cavity assessment. Ask your treating service:
- How and when the cavity will be checked again
- Whether a balloon, catheter or other barrier was used
- Whether any hormone treatment is recommended and why
- When intercourse, tampons, swimming and exercise can resume
- When trying to conceive or embryo transfer may resume
- Which symptoms require prompt or urgent review
After hysteroscopy, follow the discharge instructions from the treating service. Seek prompt medical advice for increasing pain, fever, offensive discharge, persistent vomiting or bleeding that is becoming heavier rather than settling. Seek urgent assessment for severe or rapidly worsening pain, heavy bleeding, fainting, collapse or sudden serious illness; call 000 for a life-threatening emergency.
What can intrauterine adhesions mean for fertility?
Adhesions can interfere with fertility when they reduce the functional cavity, affect the endometrium or obstruct parts of the uterine cavity. Restoring the cavity can improve the opportunity for pregnancy in some people, but hysteroscopic treatment does not guarantee conception or live birth.
Fertility after treatment also depends on age, ovarian reserve, ovulation, sperm factors, tubal function, endometrial recovery and other diagnoses. This is particularly important after unsuccessful fertility treatment because it is easy to attribute every failed cycle to the uterine cavity.
If IVF has already been unsuccessful, the review after multiple IVF failures looks at the wider pathway rather than assuming one abnormality explains every outcome.
What happens if you become pregnant after Asherman syndrome?
Pregnancy can occur after treatment of intrauterine adhesions. The outlook varies substantially with the original severity of the adhesions and other fertility factors.
Research after hysteroscopic adhesiolysis has identified possible increased placental and obstetric risks in some populations, but the evidence is largely observational and different studies include different severities of disease. This means a previous diagnosis should be disclosed to your maternity team without assuming that a complication will occur.
If you become pregnant, tell the GP, obstetrician, midwife or fertility clinic about:
- The previous diagnosis of intrauterine adhesions or Asherman syndrome
- How many hysteroscopic procedures were required
- Any previous D&C, caesarean birth or other uterine surgery
- Any information you were given about the severity or location of the adhesions
Those details can help the maternity team decide what placental assessment and pregnancy monitoring are appropriate for you.
How are pelvic adhesions outside the uterus assessed?
Pelvic adhesions outside the uterine cavity are a different problem. They may form after endometriosis, pelvic inflammatory disease, abdominal or pelvic surgery, infection or inflammation and can involve the fallopian tubes, ovaries, bowel, bladder or abdominal wall.
A hysteroscopy cannot diagnose these external adhesions. Depending on the clinical question, assessment may involve expert ultrasound, tubal imaging, MRI for selected conditions or laparoscopy. During a laparoscopy and dye test, the pelvis can be inspected and dye used to assess whether the fallopian tubes are open.
Surgery is not required merely because pelvic adhesions are possible. The benefits of another operation need to be weighed against symptoms, fertility goals, other findings and the fact that surgery itself can also lead to further adhesion formation.
Can diet, massage or supplements dissolve adhesions?
There is no evidence that massage, stretching, diet, herbs or supplements can dissolve structural scar bands inside the uterine cavity. If clinically significant intrauterine adhesions require removal, that is a hysteroscopic treatment question.
This does not mean every supportive therapy is useless. Pelvic physiotherapy may help a separate pelvic-floor problem, persistent pain or muscle guarding, for example. It should simply not be described as a treatment that removes intrauterine scar tissue.
The guide to fertility massage and the evidence explains the distinction between supportive care and treatments that alter a structural fertility problem.
Can ovulation tests help if your periods have changed?
An ovulation test cannot diagnose intrauterine adhesions. Urine ovulation predictor kits detect the rise in luteinising hormone that usually occurs before ovulation, while Asherman syndrome is a structural problem inside the uterus.
That distinction can still be useful. Someone may continue to have ovarian hormone activity and an LH surge even when menstrual bleeding has become very light because the uterine cavity or endometrium has been affected.
If you are tracking ovulation while waiting for assessment, ovulation tests can help identify the urinary LH rise, but they should not be used to rule uterine adhesions in or out. The guide to ovulation test accuracy in Australia explains what a positive or negative OPK can and cannot establish.
If you are using ovulation information mainly to time intercourse, the fertile-window guide keeps that timing question separate from whether the uterine cavity itself needs investigation.
Routine, prompt and urgent care: what should you do next?
| Situation | Useful action |
|---|---|
| Periods became noticeably lighter after a uterine procedure but you are otherwise well | Book a GP or gynaecology appointment and bring the procedure history |
| Periods have stopped, cyclic pain continues, you have recurrent miscarriage or infertility | Ask whether gynaecology, fertility or uterine-cavity assessment is appropriate |
| Pain, bleeding, fever or discharge is worsening after hysteroscopy or uterine treatment | Contact the treating service or seek prompt clinical assessment |
| Severe or rapidly worsening pain, very heavy bleeding, fainting, collapse or serious acute illness | Seek urgent emergency assessment; call 000 when symptoms are life-threatening |
What should you take to a gynaecology or fertility appointment?
A short timeline can make the consultation more useful. Where available, bring:
- The dates of miscarriages, births and uterine procedures
- D&C, hysteroscopy or operative reports
- Pathology reports if pregnancy tissue or placental tissue was removed
- Previous ultrasound, HSG or saline-sonography results
- Notes about how your period changed and when
- Previous fertility-treatment records if relevant
- Your medicine and supplement list
Ask what the clinician is trying to establish with the next test. A test should answer a defined question rather than simply adding another investigation to the list.
If you are unsure whether your overall fertility history already warrants specialist assessment, see when to see a fertility specialist in Australia.
Frequently Asked Questions about intrauterine adhesions
Can you have intrauterine adhesions with normal periods?
Yes. Small or localised adhesions may not noticeably change menstrual bleeding. Normal periods therefore do not completely exclude intrauterine adhesions, although testing should be based on the full clinical history rather than performed simply because the condition is possible.
Do intrauterine adhesions always cause pain?
No. Some people have no pain, while others experience cyclic cramping, particularly when menstrual flow is reduced. Pain alone cannot diagnose Asherman syndrome because many gynaecological, bowel, bladder and musculoskeletal conditions can cause similar symptoms.
Can adhesions return after hysteroscopic treatment?
Yes. Intrauterine adhesions can reform, particularly when the original disease was dense or extensive. Follow-up cavity assessment and any barrier, catheter or hormone plan recommended by the treating specialist are therefore important parts of care.
Does another D&C remove intrauterine adhesions?
Blind D&C is not the preferred method for treating intrauterine adhesions. Clinically significant adhesions are generally divided hysteroscopically under direct vision so the scar tissue and surrounding cavity can be seen while treatment is performed.
Can you become pregnant after Asherman syndrome?
Yes. Pregnancy is possible after treatment, but the chance for an individual depends on adhesion severity, endometrial recovery, age, tubal and sperm factors and other fertility conditions. A restored cavity does not guarantee pregnancy or live birth.
Can massage, diet or supplements dissolve uterine adhesions?
No evidence shows that massage, diet, herbs or supplements dissolve structural scar bands inside the uterine cavity. Supportive therapies may help other symptoms, but they should not replace appropriate cavity assessment or hysteroscopic treatment when treatment is clinically indicated.
Next Steps in Australia
If your periods became markedly lighter or stopped after a D&C, retained placenta, postpartum treatment or another uterine procedure, write down when the change occurred and gather any available reports. Take that history to your GP or gynaecologist and ask whether the uterine cavity needs specific assessment.
If hysteroscopy is recommended, ask whether it is diagnostic, operative or potentially both; how complex adhesions are managed; what recurrence-prevention approach is being considered; and when the cavity will be reassessed. If pregnancy is your goal, also ask when your specialist wants you to resume trying to conceive or proceed with fertility treatment.
The central question is not simply whether scar tissue exists. It is whether intrauterine adhesions are present, how much of the cavity they affect, whether they explain the symptoms or fertility problem in front of you, and what intervention is likely to provide meaningful benefit.
Last reviewed: 3 September 2026
Next scheduled review: September 2027
References
Fertility2Family articles are researched using Australian professional and regulatory guidance alongside peer-reviewed medical literature. The references below were used to research and medically review this article and provide additional reading for readers who want to explore the evidence in more detail.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Asherman Syndrome
RANZCOG Version 3 patient guidance from 2025 covering causes, symptoms, ultrasound, HSG, saline sonography, hysteroscopy, hysteroscopic treatment, recurrence, recovery and future fertility.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Miscarriage, Recurrent Miscarriage and Ectopic Pregnancy (C-Gyn 38)
Current Australian and New Zealand clinical guidance incorporating intrauterine-adhesion evidence, including post-miscarriage risk, hysteroscopic adhesiolysis and limitations in reproductive-outcome evidence.
Therapeutic Goods Administration. Asherman Syndrome and risks associated with medical devices
Australian regulator update from March 2026 describing intrauterine scarring, menstrual and fertility effects, medical-device safety considerations and RANZCOG’s role in clinical guidance.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Hysteroscopy
Australian patient information explaining hysteroscopy, why direct uterine-cavity assessment may be performed, procedural expectations and the importance of following individual recovery and safety instructions.
AAGL and European Society of Gynaecological Endoscopy. AAGL practice report: practice guidelines on intrauterine adhesions developed in collaboration with ESGE
Professional guideline addressing diagnosis, classification, hysteroscopic treatment and strategies intended to reduce recurrence after treatment of intrauterine adhesions.
American Society for Reproductive Medicine / ReproductiveFacts. Intrauterine adhesions: what are they?
Patient education covering causes, menstrual and fertility effects, diagnostic approaches and hysteroscopic treatment of intrauterine adhesions and Asherman syndrome.
Archives of Gynecology and Obstetrics. Intrauterine interventions options for preventing recurrence after hysteroscopic adhesiolysis: a systematic review and network meta-analysis of randomized controlled trials
A 2024 network meta-analysis of 21 randomised trials examining post-adhesiolysis strategies, adhesion recurrence, cavity scores, pregnancy outcomes and the uncertainty around an optimal prevention approach.
American Journal of Obstetrics and Gynecology. Treatment of intrauterine adhesions and subsequent pregnancy outcomes in an in vitro fertilization population
A 2024 IVF cohort examining live birth, endometrial thickness and placental outcomes after treatment of intrauterine adhesions, with important differences according to treatment history and disease burden.
Frontiers in Endocrinology. A meta-analysis of obstetric and neonatal outcomes in patients after treatment of hysteroscopic adhesiolysis
A 2023 meta-analysis of pregnancy outcomes after hysteroscopic adhesiolysis, identifying placental and obstetric signals while emphasising limitations in comparative evidence.
Australian and New Zealand Journal of Obstetrics and Gynaecology. Fertility and Obstetric Outcomes in Asherman Syndrome: Assessing the Impact of Hyaluronic Acid Post-Hysteroscopic Adhesiolysis
A 2026 Australian study comparing hysteroscopic adhesiolysis with and without intrauterine hyaluronic acid and reporting menstrual, repeat-surgery, fertility, obstetric and neonatal outcomes.
Healthdirect Australia. Laparoscopy and dye test
Australian consumer guidance explaining laparoscopy and dye testing, including how the pelvis and fallopian tubes can be assessed when the clinical question involves structures outside the uterine cavity.