Asherman's Syndrome - Causes, Symptoms and Treatment

Asherman's Syndrome is an acquired uterine disease. Asherman's syndrome , also called "uterine synechiae. It is characterized by the formation of adhesions (scar tissue) in the uterus. In many cases the front and back walls of the uterus stick to one another. In other cases, adhesions only occur in a small portion of the uterus. The extent of the adhesions defines whether the case is mild, moderate or severe. The adhesions can be thin or thick, can be spotty in location, or can be confluent. The cavity of the uterus is lined by the endometrium. This lining can be traumatized, typically after a dilation and curettage (D&C) done after a miscarriage , abortion , or delivery , and then develops intrauterine scars which can obliterate the cavity to a varying degree. In the extreme, the whole cavity has been scarred and occluded. Even with relatively few scars, the endometrium may fail to respond to estrogens and rests. The patient experiences secondary ameorrhea and becomes infertile. An artificial form of Asherman's syndrome can be surgically induced by uterine ablation in women with uterine bleeding problems, in lieu of hysterectomy.

There is a variant of Asherman's Syndrome that is more difficult to treat. This is a so-called "unstuck Asherman's" or endometrial sclerosis. Which may coexist with the presence of adhesions, the uterine walls are not stuck together. Instead, the endometrium has been denuded. Although curettage can cause this condition, it is more likely after uterine surgery, such as myomectomy. In these cases the endometrium, or at least its basal layer, has been removed or destroyed. Asherman's syndrome can also occur after other types of uterine surgery. It may be more likely to happen after a pregnancy-related D&C or if an infection is present in the uterus during the time of the procedure. A severe pelvic infection unrelated to surgery may also lead to Asherman's syndrome. Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States, and uterine complications such as Asherman's syndrome related to these infections are even less common.

Causes of Asherman's syndrome

Common causes of Asherman's syndrome

• Dilatation.
• Curettage.

Symptoms of Asherman's syndrome

Common Symptoms of Asherman's syndrome

• Scanty or absent periods (amenorrhea).
• Pain.
• Infertility
• Recurrent miscarriages

Treatment of Asherman's syndrome

Common Treatment of Asherman's syndrome

• Surgical treatment includes cutting and removing adhesions or scar tissue within the uterine cavity. This can usually be performed by hysteroscopy, using small instruments and a camera placed into the uterus through the cervix
• Operative hysteroscopy is used for visual inspection of the uterine cavity and dissection of scar tissue.
• Most cases of Asherman's syndrome cannot be predicted or prevented.