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Menstrual Cycle with Asherman's
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Questions to Ask Your Doctor

Diagnosis Questions

  1. What caused my Asherman’s Syndrome?
  2. Was this preventable?
  3. How often does Asherman's Syndrome occur in women?
  4. Can scarring be caused by an infection?
  5. What tests/hormone treatments would you recommend to make a proper diagnosis?
  6. What severity of Asherman’s do I have? (This and the other questions below assume you have been diagnosed.)
  7. What percentage of my cavity is open?
  8. Where is most of the scarring?
  9. What type of scarring do I have? Flat scarring (on walls of uterus) or adhesions holding the sides of the walls together? Is the scarring difficult or easy to remove?
  10. Can you tell if my scar tissue is very dense, calcified or difficult to remove?
  11. Can you tell if the scarring is covering my tubes? How difficult is it to remove the scarring in this area? Is there a risk of doing irreparable damage to my tubes?
  12. How is my endometrium? Is it continuous or one that has parts missing?
  13. How thin or thick is my endometrium?
  14. What methods would you recommend to increase the thickness or amount of endometrium? Baby aspirin? Viagra? Acupuncture? Herbal treatments?
  15. Is the hysteroscopy planned the best course of treatment at this current stage based on the information we have in front of us or is an HSG or SHG to determine Asherman’s a possibility?

Treatment Questions

  1. How do you recommend treating Asherman's? What type of surgery, hormone treatments, barrier method?
  2. Are there any treatments or ways in which I can improve my chances of success with overcoming Ashermans?
  3. If you don’t recommend surgery, what potential problems may I encounter?
  4. Is there a problem with my cervix being shut if I don’t have surgery? Am I at greater risk of developing endometriosis?
  5. Is there an increased risk of uterine or cervical cancer if my AS is untreated? How would I know if I had these types of cancer?
  6. Will my scarring get worse over time? Will it be more difficult to remove in the future?
  7. (If applicable) The scan showed a hematometra i.e. stale trapped fluid in my cavity – once this is released from my uterine cavity will there be a risk that my uterine walls will fuse together with scar tissue while it is healing? If there is a risk is there something you can do to prevent this from happening e.g. a barrier method etc?
  8. Is the first hysteroscopy planned strictly a diagnostic procedure?
  9. If you do find extensive scarring in my uterine cavity, would you consider leaving this alone (if beyond surgeon’s experience level) and discuss with me what my options are next or will you attempt to remove it then and there?
  10. If you attempt to remove it how confident are you that you will be successful? Would you consider referring me to an A-list doctor who routinely treats Asherman’s patients, to give me the best possible chance of recovery?
  11. If there is scarring and after answering these questions we decide you are the best person to remove it, how will you prevent it from reforming? Will you use a barrier method like a balloon or will you do in-office hysteroscopies to remove any further scar tissue that is reforming?

Doctor Background Questions

  1. Have you treated cases similar to mine? As severe? Did these women go on to have successful pregnancies?
  2. How many Asherman’s patients have you treated (via surgery) in an average year? What types of surgery do you perform most frequently?
  3. What procedures do you use to avoid uterine punctures?

Surgery Questions

  1. If I am a candidate for surgery, how would you handle my case? How do you treat women from out of state/country? Do you work with doctors here in my state/country?
  2. What will you do if you find the scar tissue is very dense, calcified or difficult to remove?
  3. Do you use the balloon method or other barrier methods post surgery to prevent the adhesions from reforming? Will you prescribe an antibiotic while the barrier is inside my uterus?
  4. Some doctors don’t use antibiotics after hysterscopic surgery unless a barrier method like a balloon has been placed inside the uterine cavity. However, considering all I have been through would you consider putting me on antibiotics to safe guard against infection anyway?
  5. How long does it take to schedule surgery?
  6. How long does it take to recover from surgery?
  7. What post-operative follow-up care do you recommend? When does this occur?
  8. How many surgeries would I need to correct my Asherman’s?
  9. How will you know if you have removed all of my scarring?
  10. What is the average price of surgery? Do most insurance companies pick up these expenses?
  11. What are the potential side effects/risks of doing surgery? Will my Asherman’s get worse?
  12. Is there a risk you would need to perform a hysterectomy?
  13. What instrument will you be using in my surgery? I understand that there are three types that are typically used, micro scissors, yag laser, and resectoscope (electrocautery). Please explain the benefits and risks of the type of instrument that you will use during my surgery. Is one of the above mentioned instruments more safe than another?

Post-Surgery Questions

  1. What is the prescription for hormones aftercare and how long will I be on them? Can I call the office for any questions or problems I may have with these hormones afterwards?
  2. When will I know if the operation has been successful?
  3. How/when will I find out if the scarring has reoccurred? Will it grow back after a year or if it's not there after a few months does that mean it's gone for good?
  4. When can we start trying to conceive again?
  5. Is there an advantage to becoming pregnant speedily or is it okay to try ourselves and wait without having fertility treatment?
  6. What diagnostic test do I need to find out if my tubes are open or if the AS has caused endometriosis/ damage to tubes/ovaries? When can I have this after this surgery?
  7. Would you recommend having a 3d ultrasound scan to check for scarring over having another hysteroscopy?
  8. How soon can we have intercourse?
  9. What do I do, and how can I tell, if I get an infection after surgery?
  10. Do I have antibiotics after the operation?
  11. Can I reach you by phone if I need anything after the operation?
  12. How do I know if my lining has improved - how is this measured?
  13. What percentage of my cavity was open?
  14. What percentage of my cavity is now open?
  15. Was the scar tissue dense, calcified, difficult to remove?
  16. Am I scar free?
  17. If not, why hasn’t all the scarring been removed?
  18. Is my endometrium continuous?
  19. Were the Fallopian Tubes obstructed?
  20. Have they been free from obstruction?
  21. Can you say that it was the D&C that caused my AS?
  22. What post-operative follow-up care do you recommend?
  23. For how long will I bleed?
  24. What post-surgery symptoms that I may develop that I should be concerned about?
  25. When can I go back to exercise?
  26. When is it safe to have sex again?
  27. Did you use a barrier?
  28. If so, which method did you use and why? 
  29. How effective are barriers in preventing re-scarring?
  30. How long should the barrier stay?
  31. Can any gynaecological doctor remove it?
  32. Will you provide instructions?
  33. Does the barrier pose a risk of infection?
  34. How do you address the risks of using a barrier? 
  35. Will I re-scar?
  36. Will I need another surgery?
  37. What are my chances of having a child?
  38. Do I take contraceptives? Which one? Why? For how long?
  39. Do I take hormones, antibiotics? Which one? Why?  For how long?
  40. What methods would you recommend to increase the thickness or amount of endometrium?
  41. When should I expect my period?
  42. When should I have the HSG?
  43. Would you recommend natural conception or IVF?
  44. When can I start IVF?
  45. What are the chances of conception with IVF?

Questions Regarding Hormonal Therapy Post-surgery

  1. What can I expect re my cycle and bleeding while on the estrogen?
  2. What kind of side effects can I expect from estrogen?
  3. How long will I be on hormone therapy for?
  4. When will my cycle return to normal?
  5. Will it ever be normal?
  6. Do I ovulate on the estrogen?
  7. When will I bleed after stopping the estrogen?
  8. Can I expect my bleed to be painful?
  9. What happens if I do not respond to the estrogen? Are there other options?
  10. Some of the girls are on progesterone. What is this for and why? Will I need it too?

Questions Regarding Additional Surgeries (if necessary)

  1. Where the scarring is, is this where a healthy embryo would more than likely try to attach itself?
  2. How long will the next surgery be?
  3. How does the laparoscopy work?
  4. What happens after the next surgery? When will we know my Asherman’s has been successfully treated?
  5. Will you do an HSG to check? Or another diagnostic procedure?
  6. Do you do in-office hysteroscopies where general anesthesia is not needed?
  7. Should I think about taking baby aspirin to help with lining growth?
  8. What happens if we are not successful with the next surgery?

Summary Questions

  1. What are my next steps? Where do we go from here?
  2. Would you recommend a third opinion?
  3. Do you know of any other Asherman’s Syndrome Support Groups other than the Yahoo online group?
  4. Would you be willing to testify on my behalf against my OB/GYN who performed the d&c?
International Ashermans Association

The Silent Syndrome

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