This condition refers to the presence of fibrosis and adhesions inside the cervical canal or the uterine cavity. It was named after Joseph Asherman who described it first in 1948 in a series of women with cervical stenosis and amenorrhea. In 1950, he described partial or complete obliteration of the uterine cavity secondary to trauma to the uterine body. Although relatively rare, Asherman's syndrome has increasingly been diagnosed as a result of the increasing use of the hysteroscope.
Intrauterine synechiae or adhesions are caused by trauma to the endometrium. This can result from repeated uterine cavity surgery e.g. dilatation and curettage (D&C), postpartum haemorrhage procedures and infection.
Symptoms associated with Asherman's syndrome:
- can be completely asymptomatic
- menstrual disturbances – mostly amenorrhea but also hypomenorrhoea
- cyclic abdominal pain
- ectopic pregnancy
- spontaneous miscarriage
- premature delivery
- abnormal placental implantation.
Diagnosis is based on suspicion in patients investigated for secondary amenorrhea or oligomenorrhoea with or without infertility. The diagnosis is confirmed by:
- hysteroscopy – the gold standard for accurate diagnosis
- hysterosalpingography (HSG) – the radiological findings of filling defects confirm the diagnosis in 85% of cases. HSG has the added advantage of providing information on tubal patency