Asherman syndrome
Updates to Synonym Attributes
Updates to Article Attributes
Asherman syndrome (AS) also known as uterine synechiae or intra uterine adhesionsintra-uterineintrauterine adhesions. It results from injury to the endometrium, and is often associated with infertility.
Epidemiology
There is a tendency for the condition to develop soon after a pregnancy (usually within 4 months 9). The incidence is thought to be increasing probably as a result of increased use of intra-uterineintrauterine intervention.
Clinical presentation
Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain1.
Pathology
Intra-uterineIntrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring 1. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. genital tuberculosis).
The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.
Radiographic features
Hysterosalpingogram
Intra-uterineIntrauterine adhesions are typically seen on HSG as multiple irregular linear filling defects (may give a lacunar pattern),with inability to appropriately distend the endometrial cavity 2. In severe cases there can even be complete non filling of the uterine cavity.
Pelvic ultrasound
May be seen as hyperechoic bands traversing through the endometrial cavity. Sonohysterography may be useful for evaluation.
Pelvic MRI
The adhesions are usually low signal on T2.
Treatment and prognosis
The goal of treatment is to remove adhesions and subsequently restore the normal size and shape of the uterine cavity. This is most commonly done by lysis of adhesions via hysteroscopy 3. The reproductive outcome correlates with the type of adhesions and extent of uterine cavity occlusion.
History and etymology
The condition was Initially described by Joseph Asherman in 1948 9.
Differential diagnosis
On a hysterosalpingogram consider:
-
normal
intra-uterineintrauterine longitudinal folds in anon distendednondistended uterus may sometimes mimic uterine synaechiae 4
See also
- amniotic sheets: uterine synechiae occuring in pregnancy
- amniotic band syndrome
-<p><strong>Asherman syndrome (AS) </strong>also known as <strong>uterine synechiae</strong> or <strong>intra uterine adhesions</strong>, is a condition characterised by formation of intra-uterine adhesions. It results from injury to the endometrium, and is often associated with infertility.</p><h4>Epidemiology</h4><p>There is a tendency for the condition to develop soon after a pregnancy (usually within 4 months <sup>9</sup>). The incidence is thought to be increasing probably as a result of increased use of intra-uterine intervention.</p><h4>Clinical presentation</h4><p>Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain<sup>1</sup>.</p><h4>Pathology</h4><p>Intra-uterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring<sup> 1</sup>. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. <a href="/articles/tuberculous-pelvic-inflammatory-disease">genital tuberculosis</a>).</p><p>The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.</p><h4>Radiographic features</h4><h5>Hysterosalpingogram</h5><p>Intra-uterine adhesions are typically seen on <a href="/articles/hysterosalpingogram">HSG</a> as multiple irregular linear filling defects (may give a lacunar pattern),<a href="/articles/hysterosalpingogram"> </a>with inability to appropriately distend the endometrial cavity <sup>2</sup>. In severe cases there can even be complete non filling of the uterine cavity.</p><h5>Pelvic ultrasound</h5><p>May be seen as hyperechoic bands traversing through the endometrial cavity.</p><h5>Pelvic MRI</h5><p>The adhesions are usually low signal on T2.</p><h4>Treatment and prognosis</h4><p>The goal of treatment is to remove adhesions and subsequently restore the normal size and shape of the uterine cavity. This is most commonly done by lysis of adhesions via hysteroscopy <sup>3</sup>. The reproductive outcome correlates with the type of adhesions and extent of uterine cavity occlusion.</p><h4>History and etymology</h4><p>The condition was Initially described by <strong>Joseph Asherman </strong>in 1948 <sup>9</sup>.</p><h4>Differential diagnosis</h4><p>On a <strong>hysterosalpingogram</strong> consider:</p><ul><li>-<a href="/articles/normal-intra-uterine-longitudinal-folds">normal intra-uterine longitudinal folds</a> in a non distended uterus may sometimes mimic uterine synaechiae <sup>4</sup>- +<p><strong>Asherman syndrome (AS) </strong>also known as <strong>uterine synechiae</strong>, is a condition characterised by formation of intrauterine adhesions. It results from injury to the endometrium, and is often associated with infertility.</p><h4>Epidemiology</h4><p>There is a tendency for the condition to develop soon after a pregnancy (usually within 4 months <sup>9</sup>). The incidence is thought to be increasing probably as a result of increased use of intrauterine intervention.</p><h4>Clinical presentation</h4><p>Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhoea, hypomenorrhoea, dysmenorrhoea) or abdominal pain <sup>1</sup>.</p><h4>Pathology</h4><p>Intrauterine adhesions result secondary to trauma to the basal layer of the endometrium with subsequent scarring<sup> 1</sup>. This may be from previous pregnancy, dilation and curettage, surgery, or infection (e.g. <a href="/articles/tuberculous-pelvic-inflammatory-disease">genital tuberculosis</a>).</p><p>The adhesions are composed of fibromuscular-connective tissue bands with or without surrounding superficial epithelial cells or glandular tissue.</p><h4>Radiographic features</h4><h5>Hysterosalpingogram</h5><p>Intrauterine adhesions are typically seen on <a href="/articles/hysterosalpingogram">HSG</a> as multiple irregular linear filling defects (may give a lacunar pattern),<a href="/articles/hysterosalpingogram"> </a>with inability to appropriately distend the endometrial cavity <sup>2</sup>. In severe cases there can even be complete non filling of the uterine cavity.</p><h5>Pelvic ultrasound</h5><p>May be seen as hyperechoic bands traversing through the endometrial cavity. <a title="Sonohysterography" href="/articles/sonohysterography">Sonohysterography</a> may be useful for evaluation.</p><h5>Pelvic MRI</h5><p>The adhesions are usually low signal on T2.</p><h4>Treatment and prognosis</h4><p>The goal of treatment is to remove adhesions and subsequently restore the normal size and shape of the uterine cavity. This is most commonly done by lysis of adhesions via hysteroscopy <sup>3</sup>. The reproductive outcome correlates with the type of adhesions and extent of uterine cavity occlusion.</p><h4>History and etymology</h4><p>The condition was Initially described by <strong>Joseph Asherman </strong>in 1948 <sup>9</sup>.</p><h4>Differential diagnosis</h4><p>On a <strong>hysterosalpingogram</strong> consider:</p><ul><li>
- +<a href="/articles/normal-intra-uterine-longitudinal-folds">normal intrauterine longitudinal folds</a> in a nondistended uterus may sometimes mimic uterine synaechiae <sup>4</sup>
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