Endometrial (Uterine) Scarring From Endometriosis

Scar tissue is also a result of surgery or Asherman’s syndrome

The endometrium is the lining of the uterus, or womb. Scar tissue in, on, or around the uterus is known as endometrial scarring. This scar tissue develops from trauma or inflammation

Endometriosis (endo) is a health condition that can cause thick endometrial scarring that leads to adhesions. However, other conditions such as previous surgeries, endometrial ablation (a procedure that destroys tissue), pregnancy, and Asherman’s syndrome can also cause scarring. 

This article reviews endometrial scarring and adhesions, what they are, how they occur, symptoms, diagnosis, and treatment.

Woman holding her lower abdomen.

Vincent Besnault / Getty Images

What Is Endometrial (Uterine) Scarring?

The endometrial lining is the mucus membrane that lines the uterus or womb. This lining thickens during your menstrual cycle to prepare for a possible pregnancy. If pregnancy does not occur, part of the endometrial lining sheds. This is when menstrual bleeding or a period occurs.

Damage to the endometrial lining can cause scar tissue. This can lead to adhesions that cause structures that are usually separated to adhere, or stick together. This includes structures in the pelvis (between the hips) or the front and back walls of the uterus.

While endometriosis is the most common cause of adhesions for those assigned female at birth, they can also result from other things such as pregnancy, surgery, and endometrial ablation.

What Is an Endometrial Ablation

Endometrial ablation is a minimally invasive surgery that removes a thin layer of the endometrium. The goal is to decrease heavy menstrual bleeding. 

From Endometriosis or Laparoscopy 

Endometriosis occurs when endometrial tissue or implants are displaced outside of the uterus. Tissue can build up on the ovaries, fallopian tubes, or other structures in the pelvis. 

Endometrial implants still respond to the hormones that drive your menstrual cycle. They grow and bleed, causing inflammation, pain, and scar tissue.

Previous surgical procedures, including laparoscopic surgery, can lead to clumps of thick scar tissue, causing adhesions. A laparoscope is a surgical instrument with a thin tube and a camera. It is inserted into the abdomen through a small incision during laparoscopic surgery. 

Gynecologic Symptoms 


The most common symptom of endometriosis is chronic, achy, or crampy pelvic pain. In fact, 90% of those with endometriosis have chronic pelvic pain.

Adhesions cause a different type of pain, often described as a stabbing, tugging, or pulling pain that comes and goes in different positions.

Adhesions can also cause:

  • Menstrual (period) abnormalities
  • Excessive menstrual cramping 
  • Pain during or after sexual intercourse
  • Painful urination, especially during menstrual bleeding
  • Painful bowel movements, especially during menstrual bleeding
  • Infertility (not able to get pregnant)
  • Abdominal bloating
  • Nausea, constipation, or diarrhea

Role of Inflammation 

Scar tissue forms in response to injury and inflammation. With endometriosis, the implant bleeds into the surrounding area. This causes an inflammatory reaction that leads to scarring and adhesions. Almost 38% of those with endometriosis have adhesions.

Associated Causes and Conditions 

Several health conditions can lead to endometrial scarring, including:

  • Endometriosis
  • Pelvic inflammatory disease (PID)
  • Severe infection, such as untreated sexually transmitted infections (STIs), diverticulitis (inflammation in a pocket within the small or large intestine), and appendicitis
  • Injury, trauma, or radiation treatment
  • Previous surgery
  • Adenomyosis (when endometrial lining spreads to the muscular wall of the uterus)
  • Autoimmune disorders

Health conditions that can lead to symptoms similar to endometrial scarring include:

Asherman’s Syndrome

Asherman's syndrome (AS) is a blockage in the uterus due to adhesions or synechiae. The adhesions develop due to recent pregnancy, uterine fibroids or tumors, trauma, surgery, infection, or radiation to the endometrium. This causes the front and back walls of the uterus to stick together. 

Symptoms of Asherman's syndrome include:

  • Menstrual cycle changes
  • Infertility
  • Pregnancy complications
  • Recurrent miscarriage

Effect on Fertility 

Endometrial adhesions can cause infertility, making it more challenging to get pregnant. Some people don’t find out they have endometriosis until they see their healthcare provider regarding infertility.

While the “how” is not entirely understood, several theories exist. Adhesions may block the fallopian tubes, preventing the egg and sperm from meeting. Another theory is that adhesions interfere with ovulation or cause undesirable conditions in the uterus that don’t support the implantation of a fertilized egg. 

Diagnosis 

Diagnosis begins with a medical history and physical exam, including a pelvic exam and imaging tests such as an ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI). 

Healthcare providers make a definitive diagnosis through surgery and sometimes a biopsy (removing a sample of tissue for testing in a lab) of the suspicious tissue. However, surgery is typically for treatment rather than for diagnosis alone.

It can take years before someone receives a diagnosis because endometriosis or adhesions can be mistaken for other conditions that cause chronic pelvic pain. These include:

  • Irritable bowel syndrome (IBS)
  • Interstitial cystitis (IC) (painful bladder syndrome)
  • Pelvic inflammatory disease (PID)

Contact your healthcare provider if you have any of the following criteria:

  • You have unresolved chronic pelvic pain. 
  • You are younger than 35 and have been trying to get pregnant for 12 months or longer.
  • You are over age 35 and have been trying to get pregnant for six months or longer.

Treatment for Adhesions and Scarring 

Endometriosis and endometrial scarring are complex, and symptoms vary, making them difficult to diagnose and treat. Early diagnosis and treatment are essential to prevent irreversible damage, especially to the reproductive system and nerves. 

Treatment depends on the underlying cause, your overall health, your medical history, the severity of the adhesions, your fertility concerns, and your symptoms. Look for a healthcare provider who listens to you, shows you respect, takes your symptoms seriously, and explains options for your treatment plan.

Pain Control

Mild adhesions may only require observation and pain control, including nonsteroidal anti-inflammatory drugs (NSAIDs), warm baths, or heating pads. 

Over-the-Counter (OTC) Pain Medications

If approved by your healthcare provider, you can also try the following OTC pain relievers to help with the pain: 


For mild symptoms, you can also try the following options at home:

  • Apply heat using a patch, heating pad, warm bath, or hot water bottle.
  • Use an ice pack or cool cloth (apply to the painful or inflamed area for 15 minutes several times daily).
  • Apply topical medications (on the skin), including pain-relieving patches, gels, or creams.
  • Use Boiron or Naturopathica (arnica) cream or pellets.
  • Try changing positions to see if it takes the pressure off of the nerve.
  • Practice movement or exercise such as swimming.

Medications

Moderate cases may require hormone therapy, fertility medications, or other prescription medications to treat the underlying cause or control inflammation and pain.

Surgery

Severe adhesions may require a hysteroscopy, in which the surgeon cuts out scar tissue or adhesions. Successful removal may require various surgical specialties and multiple surgeries. 

Hysterectomy

Healthcare providers may recommend a hysterectomy which is the surgical removal of the uterus and ovaries to those past childbearing age. This is different from a hysteroscopy.

However, this would be an extreme measure for those who still wish to become pregnant. If the ovaries are removed during a hysterectomy, it causes surgical menopause, which comes with other symptoms. 

Depending on the severity and location of endometrial tissue, scarring, or adhesions, surgery may require surgeons who specialize in:

Many teams also involve a radiology provider to give detailed information about where the adhesions are located and help them plan the best way to remove them. Your team may also include pain specialists, physical therapists, and psychologists.

Finding a Specialist

Endometriosis specialists are ob-gyns (obstetrician-gynecologists) with access to modern surgical equipment. This includes robotic surgery or laparoscopy. They usually work in medical centers, teaching hospitals, or private practices that utilize gynecologic surgeons. 

An endometriosis specialist has a high level of experience and training. They can refer you to a fertility specialist, endocrinologist, or another surgical specialist if needed.

Fertility Treatment

If adhesions prevent you from getting pregnant, your healthcare provider may suggest surgery or fertility treatments, depending on your age.

Minimizing Risk of Recurrence

Endometrial tissue, scars, or adhesions can return even with successful surgery. Healthcare providers may use multiple types of treatment in addition to surgery to help prevent a recurrence. 

Sometimes hormone therapy can prevent endometrial tissue from being stimulated by hormones. Not only does this help decrease symptoms, but it can also reduce the inflammation that may lead to scarring. 

Healthcare providers may also recommend pelvic floor therapy or a specialist such as a gastroenterologist to prevent complications and recurrence.

Reproductive System Health Practices

The following lifestyle modifications can help keep your reproductive system as healthy as possible:

Exercise is also essential for uterine health. It strengthens the muscles around the uterus, increases circulation, decreases body fat (which reduces the amount of excess estrogen), and decreases stress.

Summary 

Trauma and inflammation of the endometrium (lining of the uterus or womb) can cause endometrial scarring. For those assigned female at birth, endometriosis is the leading cause of scarring that leads to endometrial adhesions. 

Other conditions, such as previous surgeries, endometrial ablation, pregnancy, and Asherman’s syndrome, can also cause scarring and adhesions. Endometrial scarring can cause pain, menstrual abnormalities, infertility, and more. 

Diagnosis starts with a medical history and exam but may involve an ultrasound or MRI. A diagnosis is confirmed with surgery and, possibly, a biopsy. 

Treatment may involve observation, pain control, medications, or surgery. Depending on the situation, it may also include hormone or fertility treatment. 

Frequently Asked Questions

  • What does endometrial scarring feel like?

    Endometrial scarring can cause stabbing, pulling, or tugging pain. It’s different from endometriosis pain which is more persistent and is often described as cramping, throbbing, or aching.

  • How can you support uteran health naturally?

    To help support a healthy reproductive system and uterus, it’s important to eat a balanced diet, limit caffeine, avoid large amounts of alcohol, and drink lots of water. Exercise is also helpful as it strengthens muscles around the uterus, increases circulation, decreases body fat, and decreases excess estrogen. STI prevention measures are also key for overall reproductive health. You may also want to consider probiotics to lower the risk of bacterial vaginosis and yeast infections.

  • What does scar tissue from endometriosis look like?

    Endometriosis can lead to different types of internal scarring. These bands of connective tissue could be thin, transparent, thick, or dense. 

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Brandi Jones, MSN-ED RN-BC
Brandi is a nurse and the owner of Brandi Jones LLC. She specializes in health and wellness writing including blogs, articles, and education.