Asherman's syndrome

Question 1

Define Asherman’s syndrome. What is the pathophysiology?

Answer 1

Intrauterine adhesions

Irreversible damage of the single layer thick basal endometrium does not allow normal regeneration of the endometrium –> fibrosis and adhesion formation in the intrauterine cavity –> ‘Asherman syndrome’.

Question 2

What are the clinical features/complications of Asherman’s syndrome?

Answer 2

• Reduced or absent menstrual shedding
• Increased cramping and abdominal pain
• Infertility

Question 3

What is the aetiology of Asherman syndrome?

Answer 3

Endometritis - usually occurs after pregnancy where there has been uterine infection (endometritis) or genital TB.

Surgical - following over-curettage of the uterine cavity during surgical management of miscarriage In this ‘soft’ uterine state, the myometrium (including the basal layer) can be inadvertently excavated while attempting to evacuate these retained products of conception (RPOC) using metal instruments or suction cannulae.

Question 4

How is Asherman syndrome prevented?

Answer 4

• Adopting conservative or less traumatic surgical approach to managing RPOC
• Prevention of endometritis

Question 5

What is the management of Asherman syndrome?

Answer 5

Adhesiolysis - manual surgical breaking down of intrauterine adhesions; however this is difficult and risks further intrauterine trauma.

Question 6

When is deliberate destruction of the basal layer of the endometriuim used as treatment?

Answer 6

For heavy menstrual bleeding

Question 7

How is Asherman syndrome diagnosed?

Answer 7

Hysteroscopy