Asherman's syndrome

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This refers to the occurrence of adhesions within the uterus such that the cavity becomes partly obliterated. It accounts for 1-2% of cases of secondary amenorrhoea.

Pregnancy, trauma and infection are important aetiological factors as the condition is commonly associated with over-enthusiastic curettage and septic abortion, and also may follow TB, chronic endometriosis and prolonged rupture of membranes.

Presentation is usually with reduced menstrual flow, recurrent abortion or infertility. Hysterosalpingography (HSG) reveals multiple filling defects.

Management:

  • hysteroscopy is used to break the adhesions or to directly lyse with laser. Re-formation of the synechiae is prevented by inserting an intra-uterine device or a paediatric foley catheter for 4-8 weeks. Two cycles of cyclic oestrogen and progesterone are given to aid endometrial regeneration.

Notes:

  • maintenance of the uterine cavity by some physical means along with enhancement of endometrial growth (often facilitated by a cyclical estrogen and progestogen treatment regimen) are important steps in the treatment of intrauterine adhesions (IUA)
    • compared with the IUCD, the use of Foley catheter balloon is reported to be a safer and an equal or even more effective adjunctive method of treatment
    • an ideal adjunctive therapy following hysteroscopic adhesiolysis, would be the application of a biologically active mechanical separator that achieves two main goals, suppression of adhesion formation and promotion of epithelial healing
      • pilot studies have revealed that hysteroscopic lysis of intrauterine adhesions with amnion grafting seems to be a promising procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration (1)

Reference:

  1. Amer MI, Abd-El-Maeboud KH. Amnion graft following hysteroscopic lysis of intrauterine adhesions. J Obstet Gynaecol Res. 2006 Dec;32(6):559-66.

 

Last reviewed 01/2018