Conditions - Asherman's Syndrome

Question 1

What is the definition of Asherman’s Syndrome?

Answer 1

Formation of scar tissue (adhesions) inside the uterus

Question 2

What is the aetiology of and what are the risk factors for Asherman’s Syndrome?

Answer 2

Surgical trauma to uterus wall (usually a D&C procedure after pregnancy)

Question 3

What is the epidemiology of Asherman’s Syndrome?

Answer 3

16% after 1 D&C, 32% after 3 or more D&Cs

Approx. 20% after miscarriage

Question 4

What are the presenting symptoms of Asherman’s Syndrome?

Answer 4

Secondary amenorrhoea after a surgical procedure for a pregnancy event
- Light periods/no periods/irregular periods

Menstruation pain without any bleeding

Recurrent miscarriages

Difficulty conceiving/infertility

Question 5

What investigations are appropriate for Asherman’s Syndrome and what results are expected?

Answer 5

Hysteroscopy for diagnosis (adhesions visible in uterus)

Sonohysterography for extent of scar formation

Question 6

What is the management plan for Asherman’s Syndrome?

Answer 6

Hysteroscopic adhesiolysis (surgical breakdown of adhesions) + insertion of Foley catheter or IUCD to prevent re-formation

Then 2 cycles of cyclical oral oestrogen and progesterone to aid endometrial proliferation (restore fertility)

Question 7

What are the possible complications of Asherman’s Syndrome?

Answer 7

Infertility
Repeated miscarriages
Pain from trapped blood
(managed with same surgery?)

Question 8

What is the prognosis for patients with Asherman’s Syndrome?

Answer 8

Complication/symptom likelihood and severity depends on extent of adhesion formation but recurrence common (27.9%, higher in more severe cases)