Asherman's Syndrome

Question 1

Define Asherman’s syndrome.

Answer 1

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

Question 2

What are the causes/risk factors of Asherman’s syndrome?

Answer 2

• Endometrial resection
• D&C (dilation and curettage) for miscarriage or TOP
• Surgery – myomectomy, C section
• Endometriosis
• Infection

Question 3

What are the signs and symptoms of Asherman’s syndrome?

Answer 3

• Amenorrhoea
• Cyclical abdominal pain
• Subfertility
• Often no external physical signs

Question 4

What are the appropriate investigations for suspected Asherman’s syndrome?

Answer 4

• Imaging
  
  • Saline hysterosonography (HSG)
  • TVUSS - sub-endothelial linear striations + ‘boggy’ uterus
• Hysteroscopy

Question 5

What is the management of Asherman’s syndrome?

Answer 5

• Hysteroscopic adhesiolysis + Post-op copper IUD
  
  • PO oestrogens (2-3m) → reassess cavity
    
    • PO oestrogens induce endometrial proliferation

Question 6

What are the complications of Asherman’s syndrome?

Answer 6

• Infertility
• Miscarriage
• Menstrual disturbance
• Abnormal placentation
• Complications of operation/anaesthesia