What is Asherman's syndrome?

Asherman's syndrome is the formation of intrauterine adhesions (scarring), usually after uterine instrumentation (e.g. vigorous curettage, especially postpartum or post-abortion) or endometritis.

The adhesions damage the endometrium, causing secondary amenorrhoea or light periods, cyclical pain, infertility, and recurrent miscarriage. It is diagnosed by hysteroscopy and treated by hysteroscopic adhesiolysis.

Clinical relevance. Recognising Asherman's (secondary amenorrhoea after uterine instrumentation) leads to hysteroscopic adhesiolysis to restore the cavity.

More Detail

Asherman's syndrome

An acquired uterine cause of secondary amenorrhoea from intrauterine adhesions.

What it is

• Intrauterine adhesions/scarring that partially or completely obliterate the uterine cavity.

Causes

• Uterine instrumentation - vigorous or repeated curettage (especially after postpartum haemorrhage or miscarriage/termination).
• Endometritis (including genital tuberculosis in endemic areas).
• Uterine surgery (e.g. myomectomy entering the cavity).

Presentation

• Secondary amenorrhoea or light/scanty periods.
• Cyclical pelvic pain (if outflow partly obstructed), infertility, and recurrent miscarriage.

Diagnosis and management

• Diagnosed by hysteroscopy (or HSG/saline ultrasound showing filling defects).
• Treated by hysteroscopic adhesiolysis, often with measures to prevent re-adhesion (e.g. oestrogen to regenerate endometrium).