Asherman's Syndrome

Question 1

What is Asherman’s syndrome?

Answer 1

Asherman’s syndrome is where adhesions (sometimes called synechiae) form within the uterus, following damage to the uterus.

Question 2

What causes Asherman’s syndrome?

Answer 2

Usually Asherman’s syndrome occurs after a pregnancy-related dilatation and curettage procedure, for example in the treatment of retained products of conception (removing placental tissue left behind after birth).

It can also occur after uterine surgery (e.g. myomectomy) or severe pelvic infection (e.g. endometritis).

Endometrial curettage (scraping) can damage the basal layer of the endometrium. This damaged tissue may heal abnormally, creating scar tissue (adhesions) connecting areas of the uterus that are generally not connected. There may be adhesions binding the uterine walls together, or within the endocervix, sealing it shut.

Question 3

What are the consequences of Asherman’s syndrome?

Answer 3

These adhesions form physical obstructions and distort the pelvic organs, resulting in menstruation abnormalities, infertility and recurrent miscarriages.

Question 4

Are incidental adhesions found on hysteroscopy classed as Asherman’s syndrome?

Answer 4

Adhesions may be found incidentally during hysteroscopy. Asymptomatic adhesions are not classified as Asherman’s syndrome.

Question 5

How does Asherman’s Syndrome present?

Answer 5

Asherman’s syndrome typically presents following recent dilatation and curettage, uterine surgery or endometritis with:

Secondary amenorrhoea (absent periods)
Significantly lighter periods
Dysmenorrhoea (painful periods)
It may also present with infertility

Question 6

How is Asherman’s syndrome diagnosed?

Answer 6

There are several options for establishing a diagnosis of intrauterine adhesions:

Hysteroscopy is the gold standard investigation, and can involve dissection and treatment of the adhesions

Hysterosalpingography, where contrast is injected into the uterus and imaged with xrays

Sonohysterography, where the uterus is filled with fluid and a pelvic ultrasound is performed

MRI scan

Question 7

How is Asherman’s syndrome managed?

Answer 7

Management is by dissecting the adhesions during hysteroscopy. Reoccurrence of the adhesions after treatment is common.