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Asherman syndrome
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Asherman syndrome

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Contributors: Mitchell Linder MD
Other Resources UpToDate PubMed

Synopsis

Asherman syndrome refers to a condition of intrauterine adhesions (scar tissue) in conjunction with symptoms of abnormal or absent menstruation, painful cycles, and/or issues with infertility and recurrent pregnancy loss.

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

Look For

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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.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 07/20/2017
Last Updated: 07/25/2017
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Asherman syndrome
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Asherman syndrome : Amenorrhea, Infertility, Pelvic pain, Vaginal bleeding, Dysmenorrhea, Oligomenorrhea
Copyright © 2019 VisualDx®. All rights reserved.