Asherman's syndrome

From: Helen Dynda (
Tue Mar 27 15:14:44 2001

The patient is given both estrogen and progesterone but still does not bleed. The estrogen/progesterone regimen is repeated once more, but there is still no cramping or bleeding. An ultrasound of the patient's uterus using infused saline is obtained. It reveals the following. What is the most likely diagnosis?

Intrauterine adhesions. Intrauterine adhesions, also called "Asherman's syndrome" or intrauterine synechiae, cause blockage of part or all of the endometrium, leading to either scant menses or secondary amenorrhea. The most common cause appears to be postpartum uterine D&C, as occurred with this patient. Another possible cause is uterine surgery such as excision of a midline septum with subsequent scar-tissue formation. This condition is suggested when a patient reports secondary amenorrhea and undergoes a postpartum D&C. Diagnosis is made by a stepwise work-up as described throughout this case, and it is confirmed by either hysterosalpingogram (HSG), hysteroscopy, or saline infusion vaginal ultrasound (where a few cc of sterile saline are infused via a small catheter into the uterus as an office procedure to image the endometrial cavity). In this case, the uterus should have appeared as Figure 2. However, due to the adhesions, the uterus could not be distended despite significant pressure, giving the image seen in Figure 1. Treatment consists of hysteroscopic lysis of the adhesions, then insertion of an intrauterine device or prescription of oral estrogen for a few months to help the endometrium regrow. This condition can cause recurrent miscarriages. Treatment will lead to successful pregnancy outcomes in about 70% of patients. ll/wh3125c.hill.html?=A

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