Asherman's syndrome is an uncommon, acquired, gynecological disorder characterized by changes in the menstrual cycle. Patients experience reduced menstrual flow, increased cramping and abdominal pain, eventual cessation of menstrual cycles (amenorrhea), and, in many instances, infertility. Most often these symptoms are the result of severe inflammation of the lining of the uterus (endometriosis) that is caused by the development of bands of scar tissue that join parts of the walls of the uterus to one another, thus reducing the volume of the uterine cavity (intrauterine adhesions and synechiae). Endometrial scarring and intrauterine adhesions may occur as a result of surgical scraping or cleaning of tissue from the uterine wall (dilatation and curettage [D and C]), infections of the endometrium (e.g., tuberculosis), or other factors.
Most patients with Asherman’s syndrome present with sparse or absent menstrual blood flows. In a few instances, the menstrual cycle may be normal. In some instances, the affected individual may experience an interrupted menstrual blood flow with substantial pain.
This may occur as a result of blockage of the cervix (the neck of the uterus) by adhesions. Recurrent miscarriages and/or infertility may also be signs of this syndrome.
Asherman’s syndrome can be caused by surgical scraping or cleaning of the uterine wall (dilatation and curettage, also known as D&C). Intrauterine surgery to get rid of fibroids, or repair structural defects, or related to the use of IUD birth control devices may also result in Asherman’s syndrome.
Sporadic inflammation of the mucous membrane lining the uterus (endometriosis), or endometriosis caused by a tuberculosis infection or certain other infectious diseases may also be causes of Asherman’s syndrome.
Unless the physician is careful, the diagnosis of Asherman's syndrome may be needlessly overlooked. A simple X-ray of the uterus with a small tube placed in the cervix is usually diagnostic. However, many physicians will, in order to save time, use a small balloon catheter placed in the uterus. The latter technique will overlook a number of cases of this syndrome. The gold standard for diagnosis uses a hysteroscope that pictures the interior of the uterus directly.
Treatment
Many physicians argue against the use of lasers or other devices to remove the adhesions. These doctors claim that the use of small cutting devices is less likely to irritate the lining of the uterus or to cause infection.
Hormonal therapy is also used to encourage menstruation.
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TEXTBOOKS
Klein J, Sauer MV. Asherman Syndrome. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:308-09.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison’s Principles of Internal Medicine. 14th ed.McGraw-Hill Companies. New York, NY; 1998:2106, 2108.
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1365, 1427.
Jones III H, Wentz AC, Burnett LS., eds. Novak’s Textbook of Gynecology. 11th ed. William & Wilkins, Baltimore, MD; 1988:358-59.
REVIEW ARTICLES
Magos A. Hysteroscopic treatment of Asherman’s syndrome. Reprod Biomed Online. 2002; Suppl 3:46-51.
Hucke J, De Bruyne F, Balan P. Hysteroscopy in infertility – diagnosis and treatment including folloposcopy. Contrib Gynecol Obstet. 2000;20:13-20.
Al-Inany H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand. 2001;80:986-93.
JOURNAL ARTICLES
Yasmin H, Adeghe JH. Severe early-onset intrauterine growth restriction (IUGR) in a woman with Asherman’s syndrome. J Obstet Gynaecol. 2004;24:312-14.
Davies C, Gibson M, Holt EM, et al. Amenorrhea secondary to endometrial ablation and Asherman’s syndrome following uterine artery embolization. Clin Radiol. 2002;57:317-18.
Pal A, Babinszki A, Vajda G, et al. Diagnosis of Asherman’s syndrome with three-dimensional ultrasound. Ultrasound Obstet Gynecol. 2000;15:341-43.
Broome JD, Vancaillie TG. Fluoroscopically guided hysteroscopic division of ahesions in severe Asherman’s syndrome. Obstet Gynecol. 1999;93:1041-43.
FROM THE INTERNET
Medical Encyclopedia: Asherman’s syndrome. MedlinePlus. Update date: 1/13/2003. 2pp.
www.nlm.nih.gob/medlineplus/ency/article/001483.htm
Asherman’s Syndrome. Last updated on August 19, 2004. 4pp.
www.ashermans.org/
Asherman’s Syndrome. International Adhesions Society. Updated: March 2003. 3pp.
www.adhesions.org/asherman.htm
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