Asherman Syndrome (Uterine Synechia)

Introduction

• Description: Asherman syndrome is characterized by the scarring or occlusion of the uterine cavity after curettage, especially when performed after septic abortion or in the immediate postpartum period. Although the same changes occur following therapeutic endometrial ablation, the term is generally not applied in that setting.

• Prevalence: Uncommon (1.5% of women undergoing hysterosalpingography, up to 20% with a history of uterine curettage).

• Predominant Age: Reproductive age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Endometrial damage (excessive curettage, curettage when infection is present or in the immediate postpartum period—some intrauterine adhesions form in 30% of patients treated by curettage for missed abortion), endometrial infection (tuberculosis or schistosomiasis), scarring after myomectomy or metroplasty. A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome. Uterine compression sutures used in severe postpartum hemorrhage have been associated with intrauterine adhesions.

• Risk Factors: Instrumentation of the uterine cavity complicated by infection. Endometrial infection unrelated to instrumentation, such as tuberculosis or schistosomiasis.

Signs and Symptoms

• Amenorrhea or hypomenorrhea

• Abnormal uterine bleeding

• Cyclic pelvic pain

• Infertility

• Recurrent pregnancy loss

Diagnostic Approach