Asherman's Syndrome

Question 1

What is Asherman’s syndrome?

Answer 1

Adhesions (sometimes called synechiae) form within the uterus, following damage to the uterus.

Question 2

When does Asherman’s syndrome usually occur?

Answer 2

Occurs after:

1. Pregnancy-related dilatation and curettage procedure, for example in the treatment of retained products of conception (removing placental tissue left behind after birth)
2. Uterine surgery (e.g. myomectomy)
3. Several pelvic infection (e.g. endometritis)
4. Endometrial curettage

Question 3

Are asymptomatic adhesions classified as Asherman’s syndrome?

Answer 3

No

Question 4

What are typical symptoms of Asherman’s syndrome?

Answer 4

Typically presents following recent dilatation and curettage, uterine surgery or endometritis with:

1. Secondary amenorrhoea (absent periods)
2. Significantly lighter periods
3. Dysmenorrhoea (painful periods)
4. Infertility

Question 5

What are diagnosis options for Asherman’s syndrome?

Answer 5

1. Hysteroscopy is the gold standard investigation, and can involve dissection and treatment of the adhesions
2. Hysterosalpingography, where contrast is injected into the uterus and imaged with xrays
3. Sonohysterography, where the uterus is filled with fluid and a pelvic ultrasound is performed
4. MRI scan

Question 6

How is Asherman’s syndrome managed?

Answer 6

By dissecting the adhesions during husteroscopy - recurrence is common.