Asherman's syndrome

Question 1

What is Asherman’s syndrome?

Answer 1

Presence of intrauterine adhesions that may partially occlude or completely occlude uterine cavity.

Question 2

What is the aetiology of Asherman’s syndrome?

Answer 2

Damage to endometrium involving basal laer – owing to factors such as trauma (instrumentation) or infection. Leads to fibrosis and adhesions.

Associated with endometrial resection, excessive curettage (following miscarriage/TOP) surgery (myomectomy, C section), endometritis.

Question 3

What is the epidemiology of Asherman’s syndrome?

Answer 3

Uncommon

Question 4

What is the history/ exam of Asherman’s syndrome?

Answer 4

Menstrual disturbance (amenhorrea), cyclical abdominal pain, subfertility.

No physical signs.

Question 5

What investigations do you do for Asherman’s syndrome?

Answer 5

Imaging: HSG (radiological filing defects), saline hysterosonography.

Other: hysteroscopy

Question 6

What is the management of Asherman’s syndrome?

Answer 6

Surgical: hysteroscopic adhesiolysis (myometrial scoring may increase cavity dimensions if severely narrowed)

Post-procedure: copper IUD placed to prevent adhesion formation, PO oestrogens to incude endometrial proliferation, reassess after 2-3 months.

Question 7

What are the complications/ prognosis of Asherman’s syndrome?

Answer 7

Infertility, miscarriage, menstrual distorbance, abnormal placentation, complications of operating.

Often menstrual disturbance improves after tx. Post treatment 50% pregnancy rates, but higher complication rates in pregnancy.