Amenorrhea (Intrauterine Adhesions)

Question 1

Intrauterine adhesions a.k.a.?

Answer 1

Asherman’s syndrome

Question 2

Secondary amenorrhea?

Answer 2

Absence of menses for 6+ months in a woman with previous menses

Question 3

Intrauterine adhesions? Form when?

Answer 3

When scar tissue forms and obliterates the endometrial cavity

Urine curettage following a pregnancy

Question 4

Hysterosalpingogram?

Answer 4

Radiopaque dye injected into the endometrial cavity via transcervical catheter to evaluate endometrial cavity and fallopian tubes

Question 5

Hysteroscopy?

Answer 5

Direct visualization of the endometrial cavity with an endoscope

Question 6

Uterine sounding?

Answer 6

Assessing the depth and direction of the cervical and uterine cavity with a thin blunt probe

Question 7

Necessary to form intrauterine adhesions?

Answer 7

Endometrial trauma (especially basalis layer)

Question 8

Adhesions consist of? Adhesions with poor prognosis?

Answer 8

Avascular fibrous tissue OR in active endometrium/myometrium

Myometrial adhesions are usually vascular and carry poor prognosis

Question 9

Typically found after radiation or tuberculosis endometritis? Prognosis?

Answer 9

Atrophic and sclerotic endometrium without adhesions; poor prognosis

Question 10

Risk factors for intrauterine scar formation?

Answer 10

1. Postpartum curettage 2-4 weeks after delivery

2. Hypoestrogenic states (breast-feeding or hypogonadotrophic hypogonadism)

Question 11

When to suspect intrauterine adhesions (findings)?

Dx by?

Answer 11

1. Secondary amenorrhea with negative pregnancy test and no progestin-induced withdrawal bleeding

Gold standard – hysteroscopy
Also good – Hysterosalpingogram

Question 12

Treatment for intrauterine adhesions?

Answer 12

1. Operative hysteroscopy
2. IUD or pediatric foley catheter to prevent reformation
3. Conjugated estrogens and progesterone

Question 13

Patient with amenorrhea. A biphasic basal body temperature suggests?

Answer 13

Normal functioning of the HPG axis

Question 14

Patient with secondary amenorrhea. Elevated FSH suggests? At risk for?

Answer 14

Premature ovarian failure; osteoporosis

Question 15

Hormonal status with intrauterine adhesions?

Answer 15

Normal

Question 16

Patient with amenorrhea but cramping pain every month - suggested diagnosis?

Answer 16

Cervical stenosis (not intrauterine adhesions)

Question 17

Describe endometrial response to estrogen in Ashermann syndrome? No risk of?

Answer 17

Endometrium unresponsive to estrogen – no risk for endometrial hyperplasia