Asherman Syndrome : Etiology, Diagnosis

This is a condition in which the uterus (uterine lining) has been destroyed so much that it stops growing. There is a lot of Fibrosis seen in asherman’s syndrome. This is also known as scarring or adhesions or synechiae.

Females with Asherman syndrome do not get periods as there is no endometrium present to be shed. Such type of amenorrhea is known as Secondary amenorrhea.

Secondary amenorrhea is due to endometrial destruction. There can be many reasons for secondary amenorrhea, like PCOD.

Etiology of Asherman Syndrome

A. Endometrial Tuberculosis

• Causes tubercular endometritis 
• Healing with scarring in fibrosis 

B. Overzealous Curettage 

• Curettage is done for medical termination of pregnancy. This procedure itself causes a lot of bleeding.
• During this procedure, a sharp object is put inside the uterus, and the endometrium is scraped.
• From this endometrial lining, two strips are taken:
  • One strip called endometrial biopsy 
  • With the other strip, the anterior wall, posterior wall, left wall, right wall, Fundus, isthmus, and endocervix are scraped. This process is known as Fraction curettage or D&C.
• The Scraping of uterine muscles beyond the endometrial lining into the basal lamina causes a grating sound. This is known as overzealous curettage.

Precautions to be Taken While Curettage:

• If a Grating sound is heard will doing the curettage then curettage must be stopped. This sound is heard when deep layers of endometrium are touched by the scraping instrument.
• If one notices the bubbling of blood while performing curettage then also the procedure must be stopped then and there only.

Conditions in Which Curettage is Needed

• Abnormal Uterine Bleed- In case of Abnormal uterine bleeding, a doctor might use electrocautry which is a hand held device that runs on electricity and produces small amount of currents. These electric currents close the part of the vessel that is causing a bleed.

This solves the problem at hand but doing this procedure over and over again can cause asherman’s syndrome

• Medical Termination of Pregnancy- During the medical termination of pregnancy certain tools are used to make sure that everything has been cleaned out of the uterus. This is done throughly as and retained bits can cause futher bleeding and discomfort in the female.
• Secondary PPH- In case of seconday PPH there are again a lot of retained bits of placenta. These bits can be really harmful as they can cause bleeding in a new mother which could cause shehan’s syndrome (necrosis of anterior part of the pituitary by excessive post partum bleed) the treatment for this is also Curettage 

Sims Curette

• This is the  instrument used to take out the endometrial samplings during 
  • Biopsy
  • Curettage 
  • Suction
  • Evacuation

Also Read: Intersex: Definitions, Causes, and Support

Diagnosis of Asherman Syndrome

• Ultrasound
  • Shows endometrial fibrosis
  • There is No triple-layer lining
  • White fibrotic specs are echoic which Indicate that there is presence of hard tissues 

Hysterosalpingography (HSG)

• In this procedure a dye is injected into the uterus of the female. If there is no problem then we can observe the dye coming out of the ends  of the fallopian tubes but in case of asherman’s syndrome we will be able to observe filling defects. 
• Hysteroscopy
  • It is the Best method to visualize the uterus.
  • We can observe adhesions in hyteroscopy.
  • Her we can also Directly visualized  bands of adhesions

AFS Classification (American Fertility Society):

Also Read: Amniotic Fluid Dynamics

Treatment of Asherman Syndrome 

• Hysteroscopic Adhesiolysis
  • It is performen with scissors, electrical instruments like bipolar cautery with saline or unipolar cautery with glycine 
  • Her we go inside the uterus and cut the regions and scrape the endometrium and the Agglutinated thick scars are removed.
  • This allows the basal endometrium to grow.
  • Due to the small area of the uterine cavity, it collapses, and exudates come out this can cause the formation of adhesions again 
• IUCD Insertion: intrauterine contraceptive device like Copper -T can also be kept to prevent the formation of adhesion.
• High Dose Estrogens and Progesterone: For the regrowth of endometrium we must follow with High dose estrogens and progesterone. The medications that can be used are:
  • Estradiol valerate tablet 2 mg BD: from day 1 to 21 days)
  • Add Medroxyprogesterone acetate 10 mg BD (from 16th to 25th day).

Also Read: Mullerian Agenesis: Clinical Presentation and Treatment

Download the PrepLadder app now to access high-yield content with 24-hr Free Trial. Explore premium study resources like Video Lectures, digital notes, QBank, and Mock Tests for a seamless exam preparation. Time to begin your NEET PG coaching online with PrepLadder.