In the Shadow of Adhesions: Risk Factors and Mental Health in Asherman Syndrome

To determine the prevalence and risk factors for psychological distress in women treated for Asherman Syndrome (AS) and explore its implications for surgical management and patient-centered care.

Cross-sectional cohort study among women treated for AS.

University-affiliated hospital in the Netherlands.

Of 108 invited women diagnosed with AS, 98 (91%) completed an online questionnaire. Among them, 82 non-pregnant women (84%) and 16 pregnant women (16%) with AS were included in the analysis.

Psychological distress was assessed using the Symptom Questionnaire-48 (SQ-48) and the Hospital Anxiety and Depression Scale (HADS).

Descriptive statistics and linear regression analyses were performed to identify risk factors. Clinical and demographic data were retrieved from patient records. Among non-pregnant women (n = 82, 84%), 6% reported moderate and 10% severe depression, while 24% had moderate and 23% severe anxiety. The SQ-48 indicated clinical anxiety in 42%, hostility in 38%, cognitive problems in 31%, and reduced vitality in 51%. Treatment duration >2 years increased anxiety risk 16-fold (OR 16, 95% CI 1.3-195), while ≥6 hysteroscopies increased cognitive problems risk 14-fold (OR 14, 95% CI 2.0-97). A history of psychological treatment increased risks for anxiety (OR 6, 95% CI 1.4-21.0; OR 20, 95% CI 2.4-173.9) and cognitive problems (OR 11, 95% CI 1.3-94.5). Among pregnant women with AS, hostility scores were significantly lower than in non pregnant AS patients (p = .017, 95% CI).

Psychological distress is highly prevalent in non pregnant AS patients, particularly those undergoing prolonged treatment or multiple hysteroscopies. Gynecologic surgeons should recognize the psychological burden in this population, as it may affect treatment adherence, recovery, and patient satisfaction. Routine psychological screening, collaboration with mental health professionals, and counseling should be considered to optimize surgical outcomes and patient well-being.