Asherman's syndrome pathophysiology: Difference between revisions
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In the extreme, the whole cavity has been scarred and occluded. | In the extreme, the whole cavity has been scarred and occluded. | ||
Even with relatively few scars, the endometrium may fail to respond to [[estrogen]]s and rests. Often, patients experience secondary menstrual irregularities characterized by changes in flow and duration of bleeding ([[amenorrhea]], [[hypomenorrhea]], or [[oligomenorrhea]]) <ref name="Klein">{{cite journal |author=Klein SM, Garcia C-R |title=Asherman's syndrome: a critique and current review |journal=Fertility and Sterility |volume=24 |issue=9 |pages=722–735. |year=1973 |pmid=4725610 |doi=}}</ref> and become infertile. Menstrual anomlies are often but not always correlated with severity: adhesions restricted to only the [[cervix]] or lower uterus may block menstruation. Pain during menstruation and ovulation are also sometimes experienced, and can be attributed to blockages. | Even with relatively few scars, the endometrium may fail to respond to [[estrogen]]s and rests. Often, patients experience secondary menstrual irregularities characterized by changes in flow and duration of bleeding ([[amenorrhea]], [[hypomenorrhea]], or [[oligomenorrhea]]) <ref name="Klein">{{cite journal |author=Klein SM, Garcia C-R |title=Asherman's syndrome: a critique and current review |journal=Fertility and Sterility |volume=24 |issue=9 |pages=722–735. |year=1973 |pmid=4725610 |doi=}}</ref> and become infertile. Menstrual anomlies are often but not always correlated with severity: adhesions restricted to only the [[cervix]] or lower uterus may block menstruation. Pain during menstruation and ovulation are also sometimes experienced, and can be attributed to blockages.<ref name="pmid30936754">{{cite journal| author=Dreisler E, Kjer JJ| title=Asherman's syndrome: current perspectives on diagnosis and management. | journal=Int J Womens Health | year= 2019 | volume= 11 | issue= | pages= 191-198 | pmid=30936754 | doi=10.2147/IJWH.S165474 | pmc=6430995 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30936754 }} </ref> | ||
==References== | ==References== | ||
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Editor(s)-in-Chief: Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Canan S Fornusek, Ph.D.; Associate Editor-In-Chief: Saud Khan M.D.
Overview
Pathophysiology
The cavity of the uterus is lined by the endometrium. This lining is composed of two layers, the functional layer which is shed during menstruation and an underlying basal layer which is necessary for regenerating the functional layer.
Trauma to the basal layer, typically after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or for elective abortion triggers inflammation that allows adhesive bands to form from one side of the cavity to the other.
Abnormalities in placentation where the placental tissue burrows below the basal layer of the endometrium significantly increase the risk of developing Asherman syndrome. The extent of the adhesions defines whether the case is mild, moderate, or severe.
The adhesions can be thin or thick, spotty in location, or confluent. The adhesive bands are usually not vascular, an important consideration when discussing treatment options.
In the extreme, the whole cavity has been scarred and occluded.
Even with relatively few scars, the endometrium may fail to respond to estrogens and rests. Often, patients experience secondary menstrual irregularities characterized by changes in flow and duration of bleeding (amenorrhea, hypomenorrhea, or oligomenorrhea) [1] and become infertile. Menstrual anomlies are often but not always correlated with severity: adhesions restricted to only the cervix or lower uterus may block menstruation. Pain during menstruation and ovulation are also sometimes experienced, and can be attributed to blockages.[2]
References
- ↑ Klein SM, Garcia C-R (1973). "Asherman's syndrome: a critique and current review". Fertility and Sterility. 24 (9): 722–735. PMID 4725610.
- ↑ Dreisler E, Kjer JJ (2019). "Asherman's syndrome: current perspectives on diagnosis and management". Int J Womens Health. 11: 191–198. doi:10.2147/IJWH.S165474. PMC 6430995. PMID 30936754.