Asherman syndrome
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Synopsis
This is a rare condition found in reproductive-age women that is caused by vigorous curettage of the endometrial lining leading to intrauterine adhesions and scar formation. The degree of adhesion formation is variable, with some patients only having small amounts and others having complete obliteration of their endometrial cavity.
Procedures with the highest chance of adhesion formation include surgical completion of a miscarriage, treatment of a postpartum hemorrhage, and surgical removal of a placenta following vaginal delivery. An increase in the number of surgically treated miscarriages increases risk of adhesion formation.
There are some cases of adhesions developing unrelated to pregnancy episodes, for instance following hysteroscopic resections or abdominal myomectomies, but it is unclear how frequently this occurs.
In areas where it is prevalent, tuberculosis can infect the genital tract causing adhesions to form.
Patient may present with complaints of change in their menses (decrease or absence). Some will have painful cycles. Others will only present with a history of infertility or recurrent early pregnancy loss, as adhesions are often asymptomatic. Many cases will be asymptomatic.
Codes
ICD10CM:N85.6 – Intrauterine synechiae
SNOMEDCT:
48236007 – Asherman Syndrome
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Broad differential related to infertility and change in menses:- Other causes of infertility
- Other causes of secondary amenorrhea, including medication-induced menstrual changes
- Other causes of cyclic pelvic pain, eg, endometriosis
- Other causes of oligomenorrhea
- Pregnancy – Check pregnancy test.
- Cervical stenosis – Can do cervical probing with or without ultrasound guidance.
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Management Pearls
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Therapy
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References
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Last Reviewed:07/19/2017
Last Updated:05/17/2021
Last Updated:05/17/2021