Scar tissue inside the uterus develops in roughly 13% to 30% of women after a D&C, depending on the circumstances of the procedure. The medical term for this scarring is Asherman’s syndrome, and the wide range reflects a key reality: your risk depends heavily on when and why the D&C was performed. A D&C after a late miscarriage carries a much higher risk than one done during the first trimester.
How Risk Varies by Situation
Not all D&C procedures carry the same likelihood of scar tissue. About 13% of women develop intrauterine adhesions after a first-trimester termination. That number climbs to around 30% when the D&C follows a late spontaneous miscarriage. The timing of the procedure matters too: when a second D&C is performed two to four weeks after the initial one (for a vaginal delivery or missed miscarriage), the incidence reaches roughly 23%.
Women with recurrent miscarriages face a particularly wide risk window. Between 5% and 39% of women with a history of repeated pregnancy loss have adhesions, partly because they’ve undergone multiple uterine procedures. Each additional D&C increases the chance that the inner lining of the uterus gets damaged deeply enough to trigger scar formation. Overall, about 21.5% of women with any history of D&C have some degree of adhesions.
Why D&C Causes Scarring
During a D&C, the lining of the uterus is scraped or removed. If the instrument reaches the deeper basal layer of tissue (the layer responsible for regenerating the lining each menstrual cycle), the body repairs that damage with scar tissue instead of normal lining. These bands of scar tissue can bridge across the uterine cavity, causing the walls to partially or fully stick together.
The uterus is especially vulnerable to this kind of damage during and shortly after pregnancy, when the tissue is softer and the lining is thicker. That’s why pregnancy-related D&C procedures carry higher adhesion rates than D&Cs performed for other reasons, like abnormal bleeding or polyp removal.
Signs That Scar Tissue Has Formed
The most common sign is a noticeable change in your period after the procedure. Your menstrual flow may become significantly lighter than it was before, or your period may stop entirely. This happens because scar tissue replaces the normal uterine lining that would otherwise shed each month. If adhesions are blocking the cervix or lower uterine cavity, you might still have a period building up inside the uterus, which can cause cyclical pelvic pain or cramping without visible bleeding.
Some women don’t notice any symptoms at all, especially with mild scarring. In those cases, adhesions are often discovered only when a woman has difficulty getting pregnant or experiences recurrent miscarriages. The scar tissue can prevent an embryo from implanting properly or leave too little healthy lining to support a pregnancy.
How Scar Tissue Is Diagnosed
Hysteroscopy, a procedure where a small camera is inserted through the cervix to directly view the inside of the uterus, is the gold standard for detecting adhesions. It can identify scar tissue that other imaging methods miss entirely. In one study, uterine adhesions were found only by hysteroscopy in about 8% of cases, meaning those adhesions would have gone undetected with other tests.
An older imaging method called hysterosalpingography (HSG), which uses X-ray and dye, picks up uterine abnormalities with roughly 70% sensitivity. That means it misses about 3 in 10 cases. If your provider suspects adhesions based on your symptoms, direct visualization with a camera is the more reliable option.
Mild, Moderate, and Severe Adhesions
Adhesions are graded by how much of the uterine cavity they block and how dense the scar tissue is. Mild adhesions are thin, filmy bands that cover a small portion of the cavity. These generally respond well to treatment, and the outlook for future fertility is good. Moderate adhesions are thicker and cover more area, requiring more careful intervention. Severe adhesions can fill most or all of the uterine cavity with dense scar tissue, sometimes completely obliterating the space inside the uterus. The prognosis for severe cases is significantly less favorable, though treatment is still possible.
Treatment and Fertility Outcomes
The primary treatment is a surgical procedure called adhesiolysis, where the scar tissue is cut away using a hysteroscope. In a large study of 500 women who underwent this surgery, 67.4% achieved a live birth within three years. The miscarriage rate in that group was 33%, which is higher than the general population but still means roughly two-thirds of treated women brought home a baby.
Age plays a significant role in outcomes, as does the severity of the original scarring and whether a woman experiences a miscarriage after the surgery. Women who had at least one miscarriage after adhesiolysis had lower odds of eventually achieving a live birth, suggesting that the underlying uterine damage can persist even after scar tissue is removed.
Reducing the Risk Before It Starts
One of the most effective strategies is choosing a different procedure altogether. Manual vacuum aspiration (MVA) uses gentle suction through a flexible plastic tube instead of a sharp curette. In a study of over 1,500 women treated for first-trimester miscarriage, 1.2% of those who had a traditional D&C developed adhesions, while zero cases were reported among women treated with MVA. The World Health Organization now recommends suction methods over sharp curettage for first-trimester miscarriage specifically because of this difference in endometrial damage.
When a D&C is necessary, placing a gel barrier inside the uterus after the procedure can significantly reduce adhesion formation. A meta-analysis found that hyaluronic acid gel cut the risk of adhesions by about 58% compared to no barrier. This protective effect held regardless of whether the procedure was an abortion or another type of uterine surgery. The gel works by physically separating the uterine walls during the initial healing period, giving the lining time to regenerate before the surfaces can stick together.
If you’re scheduled for a D&C, asking your provider about suction-based alternatives or post-procedure adhesion barriers is a reasonable conversation to have, particularly if you plan to become pregnant in the future.