Dilation and curettage (D and C) is a common surgical procedure in which the lining of the womb (endometrium) is scraped away. It is carried out after a miscarriage (often routinely), after elective termination or caesarean section.
Sometimes it is also carried out after manual removal of the placenta after birth or to remove polyps or other growths from the uterus.
Despite the widespread use of D and C, women are not warned that it can result in Asherman’s Syndrome and infertility.
What is Asherman’s Syndrome?
Asherman’s Syndrome is a scarring of the uterus. In severe cases the walls of the uterus stick together or the uterus completely fills up with scar tissue and becomes solid.
The woman’s menstrual period usually becomes milder or stops altogether as the cervix is blocked up by scar tissue so there is nowhere for the menstrual blood to exit.
Infertility is a natural consequence of this.
Some women experience monthly abdominal pain as a result of retained menstrual blood but others have no symptoms.
Having a D and C after childbirth increases the likelihood of having Asherman’s Syndrome because during pregnancy, the hormone progesterone suppresses the ability of the endometrium to repair injury. The tissue, that normally grows rapidly and then sheds when a woman has a period, slows down its growth during gestation.
This means that its ability to regenerate itself after trauma is limited, putting a woman at extra risk during the post-partum period. The same is true for women who have terminations.
One study suggested that as many as 40 percent of women may develop Asherman’s Syndrome after a post-natal D and C, particularly if it was a repeat procedure. Other studies suggest one in 100 women will have the syndrome afterwards.
Whatever figure is the nearest, both figures are high enough for the syndrome to receive a great deal more public attention and for women to be informed of its possibility prior to consenting to a D and C.
Jen, who developed Asherman’s Syndrome and infertility after a D and C to remove a polyp, shares her experiences to help other women: