Asherman's Syndrome

Question 1

Definition

Answer 1

Adhesions (AKA synchiae) form within the uterua, following damage to the uterus

Question 2

Aetiology

Answer 2

• Usually occurs after pregnancy related dilatation and curettage procedure, e.g. in the treatment of retained products of conception (removing placental tissue left behind after birth)
• After uterine surgery (myomectomy)
• Several pelvic infections (e.g. endometritis)

Question 3

Pathophysiology

Answer 3

Endometrial curettage (scraping) can damage the basal later 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 uterus walls together or within the endocervix, sealing it shut.
These adhesions form physical obstructions and distort the pelvic organs, resulting in menstruation abnormalities, infertility and recurrent miscarriages.

Question 4

Asymptomatic adhesions

Answer 4

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

Question 5

Clinical presentation

Answer 5

Typically presents after recent dilatation and curettage, uterine surgery or endometritis with:
- Secondary amenorrhoea (absent periods)
- Significant lighter periods
- Dysmenorrhoea (painful periods)
- May also present with infertility

Question 6

Diagnosis

Answer 6

• GOLD STANDARD = Hysteroscopy = involveS dissection + Tx of adhesions
• Hysterosalpingography, = contrast injected into uterus + X-rayed
• Sonohysterography, = uterus is filled with fluid for pelvic USS
• MRI scan

Question 7

Treatment

Answer 7

Dissecting the adhesions during hysteroscopy.
- Reoccurrence of the adhesions after treatment is common.