Menstruation and Menstrual Disorders - Asherman's Syndrome

Question 1

What is Asherman’s Syndrome?

Answer 1

A condition where adhesions (known as synechiae) form within the uterus and consequently damage the uterus i.e. intrauterine adhesions.

Question 2

Aetiology of Asherman’s Syndrome.

Answer 2

After :-

1. Pregnancy-Related Dilation and Curettage Procedure e.g. ERPC.
2. Uterine Surgery e.g. Myomectomy.
3. Several pelvic infections e.g. endometritis.

Question 3

Pathophysiology of ERPC and Asherman’s Syndrome.

Answer 3

1. Curettage (scraping) can damage the basal layer of the endometrium.
2. The damaged tissue may heal abnormally and create scar tissue (adhesions) which connect areas of the uterus.
3. Adhesions form physical obstructions and distort the pelvic organs.

Question 4

Complications of Asherman’s Syndrome (4).

Answer 4

1. Menstruation Abnormalities.
2. Infertility.
3. Recurrent Miscarriages.
4. Urinary Tract Obstruction.

Question 5

Clinical Features of Asherman’s Syndrome (3).

Answer 5

1. Secondary Amenorrhoea.
2. Significantly Lighter Periods.
3. Dysmenorrhoea (Painful Periods).

Question 6

Investigations of Asherman’s Syndrome (5).

Answer 6

1. Diagnose only if symptomatic (not incidental hysteroscopy adhesions).
2. Gold Standard - Hysteroscopy (involve dissection and treatment).
3. Hysterosalpingography (inject contrast into uterus before X-rays).
4. Sonohysterography (fill uterus with fluid and pelvic ultrasound).
5. MRI.

Question 7

Management of Asherman’s Syndrome.

Answer 7

Hysteroscopy Dissections.