Asherman's Syndrome

Charles M March
Seminars in reproductive medicine · 2011 · vol. 29(02) , pp. 083–094 · doi:10.1055/s-0031-1272470 · PMID:21437822 · W2327139271
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Asherman's syndrome, characterized by intrauterine adhesions typically following uterine surgery, presents with varied menstrual abnormalities, infertility, and pregnancy complications, and is diagnosed and treated via hysteroscopy with techniques including adhesiolysis and stenting.

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Abstract

Asherman's syndrome is being diagnosed with increasing frequency. Although it usually occurs following curettage of the pregnant or recently pregnant uterus, any uterine surgery can lead to intrauterine adhesions (IUA). Most women with IUA have amenorrhea or hypomenorrhea, but up to a fourth have painless menses of normal flow and duration. Those who have amenorrhea may also have cyclic pelvic pain caused by outflow obstruction. The accompanying retrograde menstruation may lead to endometriosis. In addition to abnormal menses, infertility and recurrent spontaneous abortion are common complaints. Hysteroscopy is the standard method to both diagnose and treat this condition. Various techniques for adhesiolysis and for prevention of scar reformation have been advocated. The most efficacious appears to be the use of miniature scissors for adhesiolysis and the placement of a balloon stent inside the uterus immediately after surgery. Postoperative estrogen therapy is prescribed to stimulate endometrial regrowth. Follow-up studies to assure resolution of the scarring are mandatory before the patient attempts to conceive as is careful monitoring of pregnancies for cervical incompetence, placenta accreta, and intrauterine growth retardation.

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Condition tags

endometriosisinfertility

MeSH descriptors

Gynatresia Gynatresia Gynatresia Gynatresia Abortion, Spontaneous Abortion, Spontaneous Amenorrhea Amenorrhea Estrogens Estrogens Female Gynecologic Surgical Procedures Humans Hysteroscopy Infertility, Female Infertility, Female Pregnancy Tissue Adhesions Tissue Adhesions Tissue Adhesions

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