Gynae: Ashermans

Question 1

what is Asherman’s syndrome?

Answer 1

where adhesions (sometimes called synechiae) form within the uterus, following damage to the uterus.

Question 2

what usually causes Asherman’s syndrome?

Answer 2

• occurs after pregnancy-related dilatation and curettage procedure, eg treatment of retained products of conception
• after uterine surgery (e.g. myomectomy)
• several pelvic infection (e.g. endometritis)

Question 3

what does Asherman’s syndrome cause?

Answer 3

menstruation abnormalities, infertility, recurrent miscarriages

Question 4

how does Asherman’s syndrome present?

Answer 4

• Secondary amenorrhoea (absent periods)
• Significantly lighter periods
• Dysmenorrhoea (painful periods)
• It may also present with infertility.

Question 5

how is Asherman’s diagnosed?

Answer 5

• Hysteroscopy is the gold standard investigation - 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

Question 6

how is Asherman’s managed?

Answer 6

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