Asherman’s Syndrome

Asherman’s syndrome is where adhesions (sometimes called synechiae) form within the uterus, following damage to the uterus.

Usually Asherman’s syndrome occurs after a pregnancy-related dilatation and curettage procedure, for example in the treatment of retained products of conception (removing placental tissue left behind after birth). It can also occur after uterine surgery (e.g. myomectomy) or several pelvic infection (e.g. endometritis).

Endometrial curettage (scraping) can damage the basal layer 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 uterine 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. 

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

 

Presentation

Asherman’s syndrome typically presents following recent dilatation and curettage, uterine surgery or endometritis with:

  • Secondary amenorrhoea (absent periods)
  • Significantly lighter periods
  • Dysmenorrhoea (painful periods)

It may also present with infertility.

 

Diagnosis

There are several options for establishing a diagnosis of intrauterine adhesions:

  • Hysteroscopy is the gold standard investigation, and can involve dissection and treatment of the adhesions
  • Hysterosalpingography, where contrast is injected into the uterus and imaged with xrays
  • Sonohysterography, where the uterus is filled with fluid and a pelvic ultrasound is performed
  • MRI scan

 

Management

Management is by dissecting the adhesions during hysteroscopy. Reoccurrence of the adhesions after treatment is common.

 

Last updated June 2020
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