Asherman's syndrome physical examination: Difference between revisions
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{{Asherman's syndrome}} | {{Asherman's syndrome}} | ||
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==Overview== | ==Overview== | ||
Asherman's syndrome is typically occult, as such, a proper history consisting of menstrual change, infertility, dysmenorrhea, history of prior pregnancies, and history of prior uterine procedures is required. Cervical probing and dilation is usually deferred for the second clinical encounter. Ultrasound and hysteroscopy are used in conjunction to form a diagnosis. | |||
== Physical Examination == | |||
In most cases, bimanual pelvic examination does not help in diagnosis. Probing of the cervix or dilation at the initial visit is also not recommended. If cervical dilation is indicated for another procedure (eg, endometrial biopsy), physicians may experience resistance from obstructive adhesions blocking entry of the instrument. | |||
Estrogen/progestin withdrawal test was historically used, however this has fallen out of practice for diagnosing Asherman's syndrome as this test requires additional time and only delays the diagnosis. An estrogen-progestin withdrawal test is a two-month process during which the patient receives progestin alone followed by estrogen and progestin. | |||
Ultrasound is commonly used in the initial workup. A very thin endometrium lining in a patient with amenorrhea, or other irregularities with hyperechoic regions may be suggestive of an adhesive process. Further workup using a hysteroscopy is required to confirm the diagnosis. Hysteroscopy, with lysis of adhesions as indicated, can be performed in an office or operating room setting. This is diagnostic and therapeutic, as well as decreasing the likelihood of trauma to the surrounding tissue. | |||
Additional testing is done to rule out infective processes, especially for women from Tubercolosis endemic areas. <ref name="pmid28473177">{{cite journal| author=AAGL Elevating Gynecologic Surgery| title=AAGL Practice Report: Practice Guidelines on Intrauterine Adhesions Developed in Collaboration With the European Society of Gynaecological Endoscopy (ESGE). | journal=J Minim Invasive Gynecol | year= 2017 | volume= 24 | issue= 5 | pages= 695-705 | pmid=28473177 | doi=10.1016/j.jmig.2016.11.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28473177 }} </ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Saud Khan M.D.
Overview
Asherman's syndrome is typically occult, as such, a proper history consisting of menstrual change, infertility, dysmenorrhea, history of prior pregnancies, and history of prior uterine procedures is required. Cervical probing and dilation is usually deferred for the second clinical encounter. Ultrasound and hysteroscopy are used in conjunction to form a diagnosis.
Physical Examination
In most cases, bimanual pelvic examination does not help in diagnosis. Probing of the cervix or dilation at the initial visit is also not recommended. If cervical dilation is indicated for another procedure (eg, endometrial biopsy), physicians may experience resistance from obstructive adhesions blocking entry of the instrument.
Estrogen/progestin withdrawal test was historically used, however this has fallen out of practice for diagnosing Asherman's syndrome as this test requires additional time and only delays the diagnosis. An estrogen-progestin withdrawal test is a two-month process during which the patient receives progestin alone followed by estrogen and progestin.
Ultrasound is commonly used in the initial workup. A very thin endometrium lining in a patient with amenorrhea, or other irregularities with hyperechoic regions may be suggestive of an adhesive process. Further workup using a hysteroscopy is required to confirm the diagnosis. Hysteroscopy, with lysis of adhesions as indicated, can be performed in an office or operating room setting. This is diagnostic and therapeutic, as well as decreasing the likelihood of trauma to the surrounding tissue.
Additional testing is done to rule out infective processes, especially for women from Tubercolosis endemic areas. [1]
References
- ↑ AAGL Elevating Gynecologic Surgery (2017). "AAGL Practice Report: Practice Guidelines on Intrauterine Adhesions Developed in Collaboration With the European Society of Gynaecological Endoscopy (ESGE)". J Minim Invasive Gynecol. 24 (5): 695–705. doi:10.1016/j.jmig.2016.11.008. PMID 28473177.