Asherman's syndrome

Question 1

What is Asherman’s syndrome?

Answer 1

Where adhesions form within the uterus

Question 2

List some causes of Asherman’s syndrome

Answer 2

Pregnancy related dilation and curettage
Uterine surgery
Severe pelvic infection

Question 3

Describe how curettage causes asherman’s syndrome

Answer 3

Damages the basal layer of endometrium
Damaged tissue may heal abnormally, creating scar tissue (adhesions) connecting areas of the uterus that are generally not connected together
May be adhesions in the endocervix sealing it shut

Question 4

What can Asherman’s syndrome lead to?

Answer 4

Infertility
Recurrent miscarriage
Menstrual abnormalities

Question 5

Are asymptomatic adhesions considered Ashermans syndrome?

Answer 5

No

Question 6

Describe the presentation of Asherman’s syndrome

Answer 6

Secondary amenorrhoea
Significantly lighter periods
Painful periods
Infertility

Question 7

How is Asherman’s syndrome diagnosed?

Answer 7

History plus
Hysteroscopy - can involve dissection of the adhesions
Hysterosalpingography - where contrast is injected into the uterus and viewed with ultrasound images
Sonohysterography - uterus is filled with fluid and a pelvic US is performed
MRI

Question 8

How is Asherman’s managed ?

Answer 8

Dissecting the adhesions during hysteroscopy

Recurrence of adhesions after treatment is common