Asherman's syndrome overview
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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
Asherman's syndrome, also called "uterine synechiae" or intrauterine adhesions, presents a condition characterized by the presence of scars within the uterine cavity.
An artificial form of Asherman's syndrome can be surgically induced by endometrial ablation in women with excessive uterine bleeding, in lieu of hysterectomy.
Historical Perspective
The Israeli gynecologist Joseph Asherman is credited with describing and characterizing the disease, hence it is called Asherman syndrome.
Classification
Classification of Asherman's syndrome takes into account the amount of functional endometrium present, the menstrual pattern, obstetric history, and more recently the location and severity of adhesions inside the uterus. There is no data showing superiority of one system over the other.
Pathophysiology
Asherman syndrome most often is the result of vigorous scraping and damage to the basal layer of the endometrium during a dilation and curettage, which may be done for a variety of reasons. It may also occur after delivery, especially if there is uncontrolled hemorrhage, or after the elective termination of a pregnancy. Less often, it is due to sampling for endometrial cancer, or removal of endometrial polyps. It may also occur after surgery to remove uterine fibroids.
Causes
Asherman's syndrome is most commonly linked to obstetric procedures that cause abrasion of the basal layer of the endometrium. Other causes include caesarian sections, infections or pelvic radiation therapy.
Intrauterine devices have not been linked to Asherman's syndrome.
Differentiating Asherman's Syndrome from other diseases
Asherman Syndrome must be differentiated from other conditions that may cause amenorrhea and pregnancy loss, and may cause infertility.
Epidiology and Demographics
Asherman's Syndrome may occur in up to 13% of women undergoing a termination of pregnancy during the first trimester, and 30% in women undergoing a dilation and curettage (D and C) after a late spontaneous abortion. Structural placental abnormalities and previous procedures done in the uterus increase the risk.
Risk Factors
The strongest risk factors for developing Asherman Syndrome is previous obstetric curettage procedures and infections.
Screening
No screening guidelines exist for Asherman's Syndrome.
Natural History, Complications and Prognosis
Asherman's syndrome typically occurs after a triggering event such as an infection or a procedure, and is a cumulative process which may lead to infertility. Damage to the uterine cavity may also cause pain, congestion and endometriosis.