One of the first things I hear from women who are confused about their diagnosis is this: "But I've never had a D&C. How could I have ashermans?" It is one of the most important misconceptions to clear up — because it is keeping real women from getting the right investigation for years longer than it should.
Yes, the majority of asherman's syndrome cases — estimated at more than 90% — follow a dilation and curettage procedure, most commonly after pregnancy loss. But that leaves a significant group of women who developed intrauterine adhesions through entirely different pathways. Women who had a C-section. Women who had fibroids removed. Women who had a pelvic infection. Women who, as Yale Medicine acknowledges, developed ashermans with no clear preceding cause at all.
If your periods have become noticeably lighter, if they have stopped, if you are experiencing unexplained infertility or recurrent loss — and your doctor keeps dismissing the possibility of ashermans because you have never had a D&C — this article is for you.
The reason ashermans is so strongly associated with D&C comes down to biology. The recently pregnant uterus is in a uniquely vulnerable state. The endometrial basal layer — the deep regenerative layer responsible for regrowing the lining each cycle — is temporarily exposed and highly susceptible to trauma after pregnancy. A curettage performed in this window can damage the basal layer in opposing walls, causing them to fuse as they heal.
This vulnerability diminishes significantly outside of the post-pregnancy window. But it does not mean the endometrium is invulnerable to other forms of trauma — and it does not mean ashermans cannot form in other circumstances. Research published in the International Journal of Women's Health confirms that while surgical trauma to a recently pregnant uterus is the dominant cause, asherman syndrome can develop without preceding pregnancy through infection or non-pregnancy-related uterine surgery.
Here are the established pathways to ashermans that do not involve a D&C following pregnancy:
C-section involves incision into the uterine wall, and the healing process can occasionally produce adhesions — particularly if there is infection, haemorrhage, or repeat procedures. Some women develop intrauterine adhesions from the C-section incision itself or from subsequent uterine closure complications. This is an underrecognised cause of post-C-section light periods and secondary infertility.
Operative hysteroscopy to remove submucosal fibroids (myomectomy) or endometrial polyps can cause adhesions as the cavity heals, particularly when the surgery involves opposing walls of the uterus, when the fibroid is large, or when multiple procedures are performed. This is one of the more frequently missed non-D&C pathways to ashermans.
Severe or untreated infections of the uterus — including pelvic inflammatory disease (PID), genital tuberculosis, and schistosomiasis — can destroy endometrial tissue and cause scarring. Endometritis (infection of the uterine lining) is an important non-surgical cause and is sometimes missed, particularly when it is low-grade and chronic rather than acutely symptomatic. In some parts of the world, tuberculosis of the uterus is a significant cause of asherman-like scarring.
UAE is a minimally invasive procedure used to treat symptomatic fibroids by cutting off their blood supply. Because it affects blood flow to the uterus more broadly, it can in some cases damage the endometrial lining and lead to adhesion formation. Women who have UAE performed and subsequently experience very light periods or amenorrhea should consider investigation for intrauterine changes.
Surgery to correct a septate uterus or other Mullerian anomalies involves cutting into the uterine cavity. As it heals, adhesions can form — particularly if the procedure involves both walls of the cavity, or if there is any post-operative infection. Women who have had metroplasty and notice changes to their periods or fertility challenges should keep ashermans in the differential.
Radiation to the pelvic region — used in the treatment of certain cancers — can cause significant damage to the endometrium and surrounding structures, leading to scarring and adhesion formation. This is a less common pathway but is well-documented in the literature and should be considered in women with a history of pelvic radiotherapy who experience amenorrhea or very light periods.
While endometriosis primarily causes adhesions outside the uterus in the pelvis, the chronic inflammatory environment it creates can also affect the uterine cavity. Yale Medicine explicitly lists endometriosis as a linked cause of intrauterine adhesions. Women with endometriosis who also experience light periods, implantation failure, or unexplained infertility may have overlapping intrauterine changes that warrant investigation. You can read more about this in my article on endometriosis and uterine scarring.
In a small number of cases, ashermans develops with no clearly identifiable preceding event. Yale Medicine specifically states that "some people develop Asherman syndrome without any clear preceding injury or procedure" and attributes this to individual differences in susceptibility. This is not common, but it is real — and it means that a clean surgical history does not eliminate ashermans from the picture entirely.
This is important: whether ashermans was triggered by a D&C, a C-section, a fibroid removal, or an infection, the symptoms it produces are the same. Light periods. Periods that have stopped or nearly stopped. Cyclic pelvic pain with little or no menstrual flow. Unexplained infertility. Recurrent miscarriage.
The cause changes the history your doctor needs to know. It does not change the presentation or the required investigation. If you have symptoms of Asherman's syndrome and your doctor is dismissing the possibility because you have not had a D&C, you need to bring this article into the room with you.
If you have had any uterine surgery — including C-section, fibroid removal, metroplasty, or UAE — and your periods have become lighter, stopped, or you are having difficulty conceiving, please ask specifically about intrauterine adhesion assessment. A hysteroscopy is the only test that can definitively rule it out.
The reason this distinction is so clinically significant is that women without a D&C history are far less likely to have ashermans considered in their workup. A woman who had a C-section eighteen months ago, never had a D&C, is now struggling to conceive and has noticeably lighter periods than before — she may cycle through years of unexplained infertility investigations without anyone ever connecting those lighter periods to her C-section and considering an intrauterine cause.
If your fertility workup has returned normal results and you have had any of the uterine procedures or events listed above, you have a legitimate reason to specifically request a hysteroscopy. You do not need to fit the "classic" D&C profile to have this investigation justified. Learn more about how to navigate this in my article on unexplained infertility and uterine scarring.
C-section as a cause of ashermans deserves special mention because it is one of the most commonly missed pathways, and C-section rates are high. If your periods became noticeably lighter after a C-section — shorter duration, less flow, or a dramatic reduction compared to your pre-pregnancy baseline — this is worth investigating. Post-C-section amenorrhea and hypomenorrhea are documented consequences of intrauterine adhesion formation at the scar site, and they are frequently attributed to "hormonal changes after pregnancy" without the cavity ever being assessed.
Ashermans is not genetic and does not run in families, according to Yale Medicine. If you are concerned about passing on a susceptibility to your children, you can be reassured on that point.
The Complete Guide covers ashermans from every angle — including non-D&C causes, the tests to request, and how to advocate for yourself when doctors aren't connecting the dots.
Get the Complete Guide — $97Yes. While more than 90% of ashermans cases follow a pregnancy-related D&C, intrauterine adhesions can also develop after C-section, hysteroscopic fibroid or polyp removal, uterine artery embolization, surgery to correct uterine anomalies, pelvic infection or endometritis, pelvic radiation, and in rare cases with no identifiable cause. A D&C history is not required for an ashermans diagnosis.
Yes. Caesarean section is a recognised non-D&C cause of ashermans and intrauterine adhesions. The healing process after uterine incision can produce scar tissue, particularly if there is infection or complications. Women who notice significantly lighter periods or have difficulty conceiving after a C-section should ask their doctor about intrauterine adhesion assessment.
Endometriosis is listed by Yale Medicine as a cause linked to intrauterine adhesion formation, likely through the chronic inflammatory environment it creates. Endometriosis surgery can also directly cause intrauterine adhesions. Women with endometriosis who experience light periods, implantation failure, or unexplained infertility should be assessed for coexisting intrauterine scarring.
In a small number of cases, asherman syndrome develops with no clear preceding surgical event. Pelvic infections including endometritis, PID, and genital tuberculosis can cause intrauterine scarring without surgery. Additionally, some individuals appear to develop adhesions without an identifiable cause, which may relate to individual differences in healing susceptibility.
Medical Disclaimer: This article is written from personal experience and is for informational purposes only. It is not medical advice. Please consult a qualified healthcare professional for diagnosis and treatment. The Asherman's Compass does not provide medical diagnoses.