Asherman's syndrome is a condition characterized by fibrosis and/or adhesions of the endometrium that can also involve the myometrium. It is most commonly caused by overzealous postpartum curettage. Clinical features include menstrual disturbances, infertility, recurrent pregnancy loss, and pregnancy complications. Diagnosis is made through hysterosalpingography or hysteroscopy. Treatment involves hysteroscopic lysis of adhesions followed by use of balloon catheters or IUDs to separate endometrial walls and exogenous estrogen to promote re-epithelialization.

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Asherman’s Syndrome
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Asherman’s Syndrome
Fibrosis and or Adhesions of endometrium (may also include myometrium)

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Asherman’s Syndrome - Etiopathogenesis
Causes
Overzealous Post Partum Curettage (Highest Risk)
Dilatation & Curettage
Missed Abortion
Hydatiform mole
Elective Termination of Pregnancy
Chronic Infections (T.B, Schistosomiasis )
As a Post Operative Complication
Caesarean Section
Septoplasty or Metroplasty
Abdominal Myomectomy
Uterine Artery Embolisation
Pathogenesis
Bands of Fibrous Tissue , Endometrium & Myometrium
Destruction of Areas of Endometrium leads to Fibrous Healing
Clinical Features & Diagnosis
Menstrual Ds (Amenorrhoea , Hypomenorrhoea )
Infertility or Early Pregnancy Loss or recurrent miscarriage
Pregnancy Complication (Placenta accreta / previa or Preterm )
Diagnosis
Hysterosalpingography (X ray Dye Test )- Filling Defects
Hysteroscopy ( Investigation of Choice)

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Asherman’s Syndrome - Management
Management
Hysteroscopic Lysis of Adhesions (Management of Choice)
Post Adhesion Lysis use of Baloon Catheter / IUCDs to keep the walls of endometrium seperated
Post Surgery use of Exogenous Estrogen to promote rapid re-epithelialisation of endometrium
Important Examination Points
Risk of Asherman’s Syndrome highest when D&C done post PPH
Hysteroscopic Lysis of Adhesions (Management of Choice)
Post Surgery use of Exogenous Estrogen to promote rapid re-epithelialisation of endometrium

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Asherman’s Syndrome – Image Bank
Asherman’s Syndrome
Asherman’s Syndrome
Normal HSG
Asherman’s Syndrome HSG

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Hysteroscopic Findings
Normal Endometrium Fibroid Polyp
Unhealthy EndometriumSeptate UterusAsherman Syndrome