Asherman's syndrome

Question 1

Define Asherman’s syndrome.

Answer 1

Endometrial adhesions + fibrosis

Question 2

Explain the aetiology of Asherman’s syndrome.

Answer 2

Following dilation + curettage (>12w TOP/ miscarriage/ retained placenta)

Post inflammatory e.g. TB, Schistosomiasis (developing world)

Question 3

What are the risk factors of Asherman’s syndrome?

Answer 3

Surgery e.g. miscarriage curettage, C-section; removal of fibroids
Schistosomiasis

Question 4

Summarise the epidemiology of Asherman’s syndrome.

Answer 4

Rare

Question 5

Give 4 symptoms of Asherman’s syndrome.

Answer 5

Amenhorroea (sometimes normal periods)

Severe pelvic pain + retrograde menstruation

Subfertility

Recurrent miscarriage

Question 6

Recognise the signs of Asherman’s syndrome on physical examination.

Answer 6

Normal
Cannot be diagnosed on bimanual examination

Question 7

List 4 initial investigations for Asherman’s syndrome

Answer 7

Sonohysterography: Saline infusion during USS

Hysterosalpingography: contrast dye + X-ray. “Honeycomb” appearance. High false +ve rate.

TVUSS

MRI

Question 8

What is the gold standard investigation for Asherman’s?

Answer 8

Hysteroscopy
Direct visualisation of adhesions

Question 9

What is the treatment for Asherman’s syndrome?

Answer 9

Hysteroscopic resection of the adhesions
Oestrogen to stimulate healing
Intra-uterine Balloon/ Foley catheter to prevent re-adhesion

Question 10

What can be done as prevention of Asherman’s?

Answer 10

Avoid D+C: Misoprostol

US guided D+C