Asherman’s Syndrome. Have you heard of it? I had not, until I started Googling “no period after D&C”. I am so glad I did.
After Nash was born, his placenta did not pass, so I needed a D&C to remove the placenta. Now, the doctor on call that night would argue that she could have pulled it out. But after all I had just been through, that fact that she was wrist deep into my vagina really rubbed me the wrong way (no pun!) and I grabbed her arm and said, “No. More.” She protested for like a nano-second. Apparently, even after tragedy, my patented withering glare remained intact.
After losing our identical twins at 6 and 7 weeks, I was not quite up to miscarrying naturally. Doctors offered me a D&C again, so I said, “sure”. It went really smoothly and I respect my doctor. I know she did a good job, but with two procedures within 8 months of each other paired with my scar overgrowth problem (I scar easily and create just a little extra scar tissue) it was a recipe for trouble.
I expected my cycle to return 4-5 weeks later. When it didn’t, but I had cyclical pain, I thought, well, next month will be the month. My husband and I were in New Orleans the following month – I’ll never forget it. Again, the cyclical pain came and this time worse. Pressure plus cramps. And no blood. I had been tracking my cervical mucus, and I had figured I had ovulated, but why no menses? I stayed up all night searching for answers with Dr. Google. I searched with terms like: cyclical pain no menses, no period after D&C, problems after D&C. What I learned was terrifying.
Asherman’s Syndrome, also know as adhesions or scarring, is an acquired uterine condition, characterized by the formation of scar tissue inside the uterus and/or the cervix. In many cases the front and back walls of the uterus stick to one another. I feel so lucky that this was not my situation. However, at the time, I had no idea what my condition was.
In other cases, adhesions only occur in a small portion of the uterus or cervix – and this latter case was mine. The extent of the adhesions defines whether the case is mild, moderate, or severe. They are usually not vascular, which is an important when it comes to treatment. Many, many women have scarring MUCH worse than I did. However, in my case, with the cervix scarred shut I was at risk for retrograde menses that cause endometriosis and all kinds of other problems. Again, I did not know this to be the case until after my appointments with Dr. Isaacson at Newton-Wellesley.
Most patients with Asherman’s Syndrome have really light or absent periods, but some have normal periods. Some patients have no periods but feel pain at the time that their period would normally arrive each month, as I did. This pain may indicate that menstruation is occurring but the blood cannot exit the uterus because the cervix is blocked by adhesions. I can’t tell you how strange a feeling it was. It was a slightly painful pressure that felt like I needed to push or squeeze to release the bloating feeling. Recurrent miscarriage and infertility could also be symptoms.
It was through the Yahoo Group that I found Dr. Isaacson. He is what they call an “A-Lister”, which is to say he not only has some of the best outcomes, but uses the gold-standard of treatment: micro-scissors. Let me say, it is not a very comfortable procedure. As I had minimal scarring, the procedure was done in his office, and I was awake. And I got to watch the whole procedure on the big screen!
Have you had a D&C and did your cycle never return OR not return in a way that you feel it should have? Asherman’s Syndrome is NOT AS RARE as doctors let on, mostly because they perhaps feel that implicates their work. And sometimes it does! And sometimes it does not. But, in lieu of a D&C, I strongly recommend Cytotec and passing the POC yourself unless you are very concerned about testing. If you suspect you may have Asherman’s, I urge you to seek consultation with one of the doctors recommended in the Yahoo group. Run, DO NOT WALK, to the very best doctor you can get to. DO NOT let doctors use lasers, or any other method of lysing the adhesions other than micro-scissors. Your fertility hangs in the balance.
Dr. Isaacson’s office is at the Newton Wellesley hospital, so not at all in Boston proper. However, it is about a 20 minute commute on the train. I stayed in central Boston both times (in the Back Bay area, once at the Hilton and once at the Ritz Carlton – don’t judge, I am a travel advisor and do a lot of biz with RC, so naturally I would stay with a partner property) and commuted out on the Green Line. Each time was a one night stay, with the earliest appointment possible so I could catch the last flight out of Boston bound for Nashville if things ran over.
Resources:
Ashermans.org, Yahoo Support Group, Asherman’s Syndrome Awareness and Support
