Asherman's Syndrome

Asherman's syndrome is a condition where adhesions form inside the uterus causing the front and back walls to stick together. It usually follows a D&C performed after a miscarriage, termination of pregnancy, or following a retained placenta. The condition is usually much worse if there has been infection at the same time. It can also occur after surgery such as a myomectomy, Caesarean section, or a foreign body such as an IUCD.

Symptoms
Asherman's syndrome usually causes a reduction or complete cessation of the menstrual flow and is  often associated with pain. It is also cause infertility and recurrent miscarriage.

Diagnosis and treatment
Asherman's syndrome can be diagnosed by hysterosalpingogram, saline sonography or hysteroscopy.  3D ultrasound is also useful in assessing the endometrium. Treatment is by hysteroscopic division of the adhesions at the time of the initial hysteroscopy.  In more severe cases we will usually insert a stent combined with high-dose oestrogen therapy for one or two months following surgery. The stent is usually removed after a month or so and this will divide any small adhesions which may have reformed.

The images below show a hysterosalpingogram which shows the presence of an isolated adhesion within the uterus.



Follow this link for a nice article on Asherman's Syndrome written by Martine Gallie



© Adrian Lower 2014