Asherman's syndrome: Difference between revisions
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[[File:Uterine Fibroids.png|thumb|500px|Uterine_Fibroids]] | {{SI}} | ||
{{Infobox medical condition | |||
| name = Asherman's syndrome | |||
| image = [[File:Ultrasound_of_Asherman's_syndrome.jpg|left|thumb|Ultrasound image of Asherman's syndrome]] | |||
| caption = Ultrasound image showing intrauterine adhesions characteristic of Asherman's syndrome | |||
| field = [[Gynecology]] | |||
| synonyms = Intrauterine adhesions, intrauterine synechiae | |||
| symptoms = [[Menstrual disorder]], [[infertility]], recurrent [[miscarriage]], [[pelvic pain]] | |||
| complications = [[Infertility]], [[amenorrhea]], [[dysmenorrhea]] | |||
| onset = Typically after uterine surgery or infection | |||
| duration = Chronic | |||
| causes = [[Uterine surgery]], [[infection]], [[trauma]] | |||
| risks = [[Dilation and curettage]], [[cesarean section]], [[endometrial ablation]] | |||
| diagnosis = [[Hysteroscopy]], [[hysterosalpingography]], [[ultrasound]] | |||
| differential = [[Endometrial atrophy]], [[uterine fibroids]], [[endometrial polyps]] | |||
| prevention = Careful surgical technique, use of [[intrauterine device]] post-surgery | |||
| treatment = [[Hysteroscopic surgery]], [[hormone therapy]] | |||
| prognosis = Variable, depends on severity and treatment | |||
| frequency = Rare, exact prevalence unknown | |||
}} | |||
[[File:Uterine Fibroids.png|left|thumb|500px|Uterine_Fibroids]] | |||
Asherman's Syndrome (AS), also known as intrauterine adhesions (IUA) or intrauterine synechiae, is an acquired uterine condition characterized by the formation of scar tissue within the uterine cavity. This scar tissue can lead to the walls of the uterus sticking together, resulting in various menstrual irregularities, infertility, and pregnancy complications. | Asherman's Syndrome (AS), also known as intrauterine adhesions (IUA) or intrauterine synechiae, is an acquired uterine condition characterized by the formation of scar tissue within the uterine cavity. This scar tissue can lead to the walls of the uterus sticking together, resulting in various menstrual irregularities, infertility, and pregnancy complications. | ||
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[[File:Hysteroscopy of Asherman's Syndrome cropped.jpg|left|thumb |px500|Hysteroscopy of Asherman's Syndrome]] | |||
[[File:Hysteroscopy of Asherman's Syndrome cropped.jpg|thumb |px500|Hysteroscopy of Asherman's Syndrome]] | [[Image:HSG Ashermans syndrome.jpg|left|thumb|[[Hysterosalpingography|HSG]] view. Note: not the same uterus as in ultrasound or hysteroscopic view; this uterus appears to be [[T-shaped uterus|T-shaped]].]] | ||
[[Image:HSG Ashermans syndrome.jpg|thumb|[[Hysterosalpingography|HSG]] view. Note: not the same uterus as in ultrasound or hysteroscopic view; this uterus appears to be [[T-shaped uterus|T-shaped]].]] | |||
== History == | == History == | ||
The condition was first described by Heinrich Fritsch in 1894 and later extensively characterized by Israeli gynecologist Joseph Asherman in 1948. It is also referred to as Fritsch-Asherman Syndrome in recognition of both contributors. | The condition was first described by Heinrich Fritsch in 1894 and later extensively characterized by Israeli gynecologist Joseph Asherman in 1948. It is also referred to as Fritsch-Asherman Syndrome in recognition of both contributors. | ||
[[File:Hysteroscopy of Asherman's Syndrome.jpg|left|thumb|[[Hysteroscopy|Hysteroscopic]] view.]] | |||
[[File:Hysteroscopy of Asherman's Syndrome.jpg|thumb|[[Hysteroscopy|Hysteroscopic]] view.]] | [[File:Amniotic sheet.jpg|left|thumb|amniotic sheet on ultrasound]] | ||
[[File:Amniotic sheet.jpg|thumb|amniotic sheet on ultrasound]] | |||
== Causes == | == Causes == | ||
Asherman's Syndrome typically arises from trauma to the basal layer of the endometrium, the inner lining of the uterus. Common causes include: | Asherman's Syndrome typically arises from trauma to the basal layer of the endometrium, the inner lining of the uterus. Common causes include: | ||
* '''[[Dilation and Curettage (D&C)]]''': Procedures performed after miscarriages, childbirth, or elective abortions can damage the endometrial lining, leading to scar formation. | * '''[[Dilation and Curettage (D&C)]]''': Procedures performed after miscarriages, childbirth, or elective abortions can damage the endometrial lining, leading to scar formation. | ||
* '''[[Pelvic Surgeries]]''': Surgeries such as cesarean sections or myomectomies (removal of fibroids) can result in intrauterine adhesions. | * '''[[Pelvic Surgeries]]''': Surgeries such as cesarean sections or myomectomies (removal of fibroids) can result in intrauterine adhesions. | ||
* '''[[Infections]]''': Severe pelvic infections, including genital tuberculosis, can cause significant scarring within the uterus. | * '''[[Infections]]''': Severe pelvic infections, including genital tuberculosis, can cause significant scarring within the uterus. | ||
* '''[[Radiation Therapy]]''': Pelvic irradiation for cancer treatment may lead to endometrial damage and subsequent adhesion formation. | * '''[[Radiation Therapy]]''': Pelvic irradiation for cancer treatment may lead to endometrial damage and subsequent adhesion formation. | ||
== Symptoms == | == Symptoms == | ||
The clinical presentation of Asherman's Syndrome varies depending on the extent and location of the adhesions. Common symptoms include: | The clinical presentation of Asherman's Syndrome varies depending on the extent and location of the adhesions. Common symptoms include: | ||
* '''[[Menstrual Irregularities]]''': These can range from reduced menstrual flow (hypomenorrhea) to complete absence of menstruation (amenorrhea). | * '''[[Menstrual Irregularities]]''': These can range from reduced menstrual flow (hypomenorrhea) to complete absence of menstruation (amenorrhea). | ||
* '''[[Infertility]]''': Adhesions can interfere with implantation or block the passage of sperm, leading to difficulties in conceiving. | * '''[[Infertility]]''': Adhesions can interfere with implantation or block the passage of sperm, leading to difficulties in conceiving. | ||
* '''[[Recurrent Miscarriages]]''': Scar tissue may compromise the uterine environment, increasing the risk of pregnancy loss. | * '''[[Recurrent Miscarriages]]''': Scar tissue may compromise the uterine environment, increasing the risk of pregnancy loss. | ||
* '''[[Pelvic Pain]]''': Some women may experience discomfort or pain, especially during menstruation or sexual intercourse. | * '''[[Pelvic Pain]]''': Some women may experience discomfort or pain, especially during menstruation or sexual intercourse. | ||
== Diagnosis == | == Diagnosis == | ||
Accurate diagnosis is crucial for effective management. Diagnostic methods include: | Accurate diagnosis is crucial for effective management. Diagnostic methods include: | ||
* '''[[Hysteroscopy]]''': This is the gold standard for diagnosing Asherman's Syndrome. It involves inserting a thin, lighted device into the uterus to directly visualize and assess the extent of adhesions. | * '''[[Hysteroscopy]]''': This is the gold standard for diagnosing Asherman's Syndrome. It involves inserting a thin, lighted device into the uterus to directly visualize and assess the extent of adhesions. | ||
* '''[[Hysterosalpingography (HSG)]]''': An X-ray procedure where contrast dye is injected into the uterus and fallopian tubes to detect filling defects indicative of adhesions. | * '''[[Hysterosalpingography (HSG)]]''': An X-ray procedure where contrast dye is injected into the uterus and fallopian tubes to detect filling defects indicative of adhesions. | ||
* '''[[Sonohysterography]]''': An ultrasound technique that uses saline infusion to outline the uterine cavity, helping to identify irregularities. | * '''[[Sonohysterography]]''': An ultrasound technique that uses saline infusion to outline the uterine cavity, helping to identify irregularities. | ||
* '''[[Transvaginal Ultrasound]]''': While less specific, it can provide initial clues, especially when combined with other imaging modalities. | * '''[[Transvaginal Ultrasound]]''': While less specific, it can provide initial clues, especially when combined with other imaging modalities. | ||
== Classification == | == Classification == | ||
Several classification systems have been developed to categorize the severity of Asherman's Syndrome based on factors such as the extent of adhesions and menstrual patterns. These classifications aid in predicting treatment outcomes and guiding management strategies. | Several classification systems have been developed to categorize the severity of Asherman's Syndrome based on factors such as the extent of adhesions and menstrual patterns. These classifications aid in predicting treatment outcomes and guiding management strategies. | ||
== Treatment == | == Treatment == | ||
The primary goal of treatment is to restore the normal anatomy and function of the uterine cavity. Treatment options include: | The primary goal of treatment is to restore the normal anatomy and function of the uterine cavity. Treatment options include: | ||
* '''[[Surgical Adhesiolysis]]''': Hysteroscopic surgery is performed to cut and remove adhesions, restoring the uterine cavity's normal structure. | * '''[[Surgical Adhesiolysis]]''': Hysteroscopic surgery is performed to cut and remove adhesions, restoring the uterine cavity's normal structure. | ||
* '''[[Post-Surgical Measures]]''': To prevent reformation of adhesions, methods such as the insertion of intrauterine devices (IUDs), application of barrier gels, or estrogen therapy may be employed to promote healing of the endometrial lining. | * '''[[Post-Surgical Measures]]''': To prevent reformation of adhesions, methods such as the insertion of intrauterine devices (IUDs), application of barrier gels, or estrogen therapy may be employed to promote healing of the endometrial lining. | ||
* '''[[Hormonal Therapy]]''': Estrogen therapy is often prescribed post-surgery to stimulate endometrial regeneration and prevent the walls of the uterus from sticking together during the healing process. | * '''[[Hormonal Therapy]]''': Estrogen therapy is often prescribed post-surgery to stimulate endometrial regeneration and prevent the walls of the uterus from sticking together during the healing process. | ||
== Prognosis == | == Prognosis == | ||
The success of treatment largely depends on the severity of the adhesions and the promptness of intervention. Mild to moderate cases often have favorable outcomes with restored menstrual function and the potential for successful pregnancies. Severe cases, especially those with extensive scarring, may have a guarded prognosis, and fertility may remain compromised. | The success of treatment largely depends on the severity of the adhesions and the promptness of intervention. Mild to moderate cases often have favorable outcomes with restored menstrual function and the potential for successful pregnancies. Severe cases, especially those with extensive scarring, may have a guarded prognosis, and fertility may remain compromised. | ||
== Prevention == | == Prevention == | ||
Preventative strategies focus on minimizing uterine trauma and include: | Preventative strategies focus on minimizing uterine trauma and include: | ||
* '''[[Gentle Surgical Techniques]]''': Utilizing careful and minimally invasive methods during uterine surgeries to reduce endometrial damage. | * '''[[Gentle Surgical Techniques]]''': Utilizing careful and minimally invasive methods during uterine surgeries to reduce endometrial damage. | ||
* '''[[Prompt Treatment of Infections]]''': Early and effective management of pelvic infections to prevent the development of scar tissue. | * '''[[Prompt Treatment of Infections]]''': Early and effective management of pelvic infections to prevent the development of scar tissue. | ||
* '''[[Alternative Management of Miscarriages]]''': Considering medical management or expectant management of miscarriages when appropriate, to reduce the need for surgical interventions like D&C. | * '''[[Alternative Management of Miscarriages]]''': Considering medical management or expectant management of miscarriages when appropriate, to reduce the need for surgical interventions like D&C. | ||
== Epidemiology == | == Epidemiology == | ||
The exact prevalence of Asherman's Syndrome is challenging to determine due to underdiagnosis. However, it is estimated that up to 25% of women who undergo D&C after a miscarriage or delivery may develop intrauterine adhesions. The risk increases with the number of uterine surgeries performed. | The exact prevalence of Asherman's Syndrome is challenging to determine due to underdiagnosis. However, it is estimated that up to 25% of women who undergo D&C after a miscarriage or delivery may develop intrauterine adhesions. The risk increases with the number of uterine surgeries performed. | ||
== Complications == | == Complications == | ||
If left untreated, Asherman's Syndrome can lead to several complications: | If left untreated, Asherman's Syndrome can lead to several complications: | ||
* '''[[Chronic Pelvic Pain]]''': Ongoing discomfort due to trapped blood or menstrual debris. | * '''[[Chronic Pelvic Pain]]''': Ongoing discomfort due to trapped blood or menstrual debris. | ||
* '''[[Endometriosis]]''': Retrograde menstruation caused by blocked menstrual flow can lead to the development of endometrial tissue outside the uterus. | * '''[[Endometriosis]]''': Retrograde menstruation caused by blocked menstrual flow can lead to the development of endometrial tissue outside the uterus. | ||
* '''[[Obstetric Complications]]''': Increased risks during pregnancy, such as abnormal placentation (e.g., placenta accreta), preterm labor, and uterine rupture. | * '''[[Obstetric Complications]]''': Increased risks during pregnancy, such as abnormal placentation (e.g., placenta accreta), preterm labor, and uterine rupture. | ||
== Research and Future Directions == | == Research and Future Directions == | ||
Ongoing research aims to improve the understanding and management of Asherman's Syndrome. Areas of interest include: | Ongoing research aims to improve the understanding and management of Asherman's Syndrome. Areas of interest include: | ||
* '''[[Stem Cell Therapy]]''': Investigating the potential of stem cells to regenerate damaged endometrial tissue. | * '''[[Stem Cell Therapy]]''': Investigating the potential of stem cells to regenerate damaged endometrial tissue. | ||
* '''[[Novel Surgical Techniques]]''': Developing advanced minimally invasive procedures to reduce the risk of adhesion formation. | * '''[[Novel Surgical Techniques]]''': Developing advanced minimally invasive procedures to reduce the risk of adhesion formation. | ||
* '''[[Biomaterials]]''': Exploring the use of new barrier materials to prevent adhesion reformation after surgery. | * '''[[Biomaterials]]''': Exploring the use of new barrier materials to prevent adhesion reformation after surgery. | ||
== See Also == | == See Also == | ||
* '''[[Endometrial ablation]]''' | * '''[[Endometrial ablation]]''' | ||
* '''[[Hysteroscopic surgery]]''' | * '''[[Hysteroscopic surgery]]''' | ||
| Line 122: | Line 92: | ||
* '''[[Minimally invasive gynecology]]''' | * '''[[Minimally invasive gynecology]]''' | ||
* '''[[Women's health]]''' | * '''[[Women's health]]''' | ||
== External Links == | == External Links == | ||
* '''[https://www.ashermans.org/ Asherman's Syndrome Support Group]''' | * '''[https://www.ashermans.org/ Asherman's Syndrome Support Group]''' | ||
* '''[https://www.acog.org/ The American College of Obstetricians and Gynecologists]''' | * '''[https://www.acog.org/ The American College of Obstetricians and Gynecologists]''' | ||
Latest revision as of 17:12, 4 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC
| Asherman's syndrome | |
|---|---|
 | |
| Synonyms | Intrauterine adhesions, intrauterine synechiae |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Menstrual disorder, infertility, recurrent miscarriage, pelvic pain |
| Complications | Infertility, amenorrhea, dysmenorrhea |
| Onset | Typically after uterine surgery or infection |
| Duration | Chronic |
| Types | N/A |
| Causes | Uterine surgery, infection, trauma |
| Risks | Dilation and curettage, cesarean section, endometrial ablation |
| Diagnosis | Hysteroscopy, hysterosalpingography, ultrasound |
| Differential diagnosis | Endometrial atrophy, uterine fibroids, endometrial polyps |
| Prevention | Careful surgical technique, use of intrauterine device post-surgery |
| Treatment | Hysteroscopic surgery, hormone therapy |
| Medication | N/A |
| Prognosis | Variable, depends on severity and treatment |
| Frequency | Rare, exact prevalence unknown |
| Deaths | N/A |
Asherman's Syndrome (AS), also known as intrauterine adhesions (IUA) or intrauterine synechiae, is an acquired uterine condition characterized by the formation of scar tissue within the uterine cavity. This scar tissue can lead to the walls of the uterus sticking together, resulting in various menstrual irregularities, infertility, and pregnancy complications.
History[edit]
The condition was first described by Heinrich Fritsch in 1894 and later extensively characterized by Israeli gynecologist Joseph Asherman in 1948. It is also referred to as Fritsch-Asherman Syndrome in recognition of both contributors.
Causes[edit]
Asherman's Syndrome typically arises from trauma to the basal layer of the endometrium, the inner lining of the uterus. Common causes include:
- Dilation and Curettage (D&C): Procedures performed after miscarriages, childbirth, or elective abortions can damage the endometrial lining, leading to scar formation.
- Pelvic Surgeries: Surgeries such as cesarean sections or myomectomies (removal of fibroids) can result in intrauterine adhesions.
- Infections: Severe pelvic infections, including genital tuberculosis, can cause significant scarring within the uterus.
- Radiation Therapy: Pelvic irradiation for cancer treatment may lead to endometrial damage and subsequent adhesion formation.
Symptoms[edit]
The clinical presentation of Asherman's Syndrome varies depending on the extent and location of the adhesions. Common symptoms include:
- Menstrual Irregularities: These can range from reduced menstrual flow (hypomenorrhea) to complete absence of menstruation (amenorrhea).
- Infertility: Adhesions can interfere with implantation or block the passage of sperm, leading to difficulties in conceiving.
- Recurrent Miscarriages: Scar tissue may compromise the uterine environment, increasing the risk of pregnancy loss.
- Pelvic Pain: Some women may experience discomfort or pain, especially during menstruation or sexual intercourse.
Diagnosis[edit]
Accurate diagnosis is crucial for effective management. Diagnostic methods include:
- Hysteroscopy: This is the gold standard for diagnosing Asherman's Syndrome. It involves inserting a thin, lighted device into the uterus to directly visualize and assess the extent of adhesions.
- Hysterosalpingography (HSG): An X-ray procedure where contrast dye is injected into the uterus and fallopian tubes to detect filling defects indicative of adhesions.
- Sonohysterography: An ultrasound technique that uses saline infusion to outline the uterine cavity, helping to identify irregularities.
- Transvaginal Ultrasound: While less specific, it can provide initial clues, especially when combined with other imaging modalities.
Classification[edit]
Several classification systems have been developed to categorize the severity of Asherman's Syndrome based on factors such as the extent of adhesions and menstrual patterns. These classifications aid in predicting treatment outcomes and guiding management strategies.
Treatment[edit]
The primary goal of treatment is to restore the normal anatomy and function of the uterine cavity. Treatment options include:
- Surgical Adhesiolysis: Hysteroscopic surgery is performed to cut and remove adhesions, restoring the uterine cavity's normal structure.
- Post-Surgical Measures: To prevent reformation of adhesions, methods such as the insertion of intrauterine devices (IUDs), application of barrier gels, or estrogen therapy may be employed to promote healing of the endometrial lining.
- Hormonal Therapy: Estrogen therapy is often prescribed post-surgery to stimulate endometrial regeneration and prevent the walls of the uterus from sticking together during the healing process.
Prognosis[edit]
The success of treatment largely depends on the severity of the adhesions and the promptness of intervention. Mild to moderate cases often have favorable outcomes with restored menstrual function and the potential for successful pregnancies. Severe cases, especially those with extensive scarring, may have a guarded prognosis, and fertility may remain compromised.
Prevention[edit]
Preventative strategies focus on minimizing uterine trauma and include:
- Gentle Surgical Techniques: Utilizing careful and minimally invasive methods during uterine surgeries to reduce endometrial damage.
- Prompt Treatment of Infections: Early and effective management of pelvic infections to prevent the development of scar tissue.
- Alternative Management of Miscarriages: Considering medical management or expectant management of miscarriages when appropriate, to reduce the need for surgical interventions like D&C.
Epidemiology[edit]
The exact prevalence of Asherman's Syndrome is challenging to determine due to underdiagnosis. However, it is estimated that up to 25% of women who undergo D&C after a miscarriage or delivery may develop intrauterine adhesions. The risk increases with the number of uterine surgeries performed.
Complications[edit]
If left untreated, Asherman's Syndrome can lead to several complications:
- Chronic Pelvic Pain: Ongoing discomfort due to trapped blood or menstrual debris.
- Endometriosis: Retrograde menstruation caused by blocked menstrual flow can lead to the development of endometrial tissue outside the uterus.
- Obstetric Complications: Increased risks during pregnancy, such as abnormal placentation (e.g., placenta accreta), preterm labor, and uterine rupture.
Research and Future Directions[edit]
Ongoing research aims to improve the understanding and management of Asherman's Syndrome. Areas of interest include:
- Stem Cell Therapy: Investigating the potential of stem cells to regenerate damaged endometrial tissue.
- Novel Surgical Techniques: Developing advanced minimally invasive procedures to reduce the risk of adhesion formation.
- Biomaterials: Exploring the use of new barrier materials to prevent adhesion reformation after surgery.
See Also[edit]
- Endometrial ablation
- Hysteroscopic surgery
- Uterine synechiae
- Fertility preservation
- Reproductive surgery
- Menstrual disorders
- Pelvic Inflammatory Disease
- Gynecological imaging
- Minimally invasive gynecology
- Women's health
External Links[edit]
- Asherman's Syndrome Support Group
- The American College of Obstetricians and Gynecologists
- Royal College of Obstetricians and Gynaecologists
- World Health Organization - Women's Health
- Endometriosis Foundation of America
| Female diseases of the pelvis and genitals | ||||||||||||||||||||||||||||||
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