Asherman's syndrome (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Synonyms and Keywords: Uterine synechiae

Overview
Asherman syndrome is the formation of intrauterine adhesions (scar tissue), which typically develop after uterine surgery.

What are the symptoms of Asherman’s syndrome?

 * The adhesions may cause amenorrhea (lack of menstrual periods), repeated miscarriages, and infertility.


 * However, such symptoms could be related to several conditions. They are more likely to indicate Asherman syndrome if they occur suddenly after a D&C or other uterine surgery.

What causes Asherman’s syndrome?

 * Asherman syndrome is a rare condition.


 * In most cases, it occurs in women who have had several dilatation and curettage procedures.


 * A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome.


 * Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States, and uterine complications such as Asherman syndrome related to these infections are even less common.

When to seek urgent medical care?

 * Call your health care provider if your menstrual periods do not resume after a gynecologic or obstetrical procedure.


 * An evaluation for infertility is also warranted if you are unable to achieve a pregnancy after 6 to 12 months of trying.

Diagnosis

 * A pelvic exam is usually normal.


 * Tests may include:
 * Blood tests to detect tuberculosis or schistosomiasis
 * Hysteroscopy
 * Hysterosonogram
 * Infertility evaluation
 * Transvaginal ultrasound examination

Treatment options

 * Treatment involves surgery to cut and remove the adhesions or scar tissue. This can usually be done with hysteroscopy, which uses small instruments and a camera placed into the uterus through the cervix.


 * After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent adhesions from returning. Your health care provider may place a small balloon inside the uterus for several days and prescribe estrogen therapy while the uterine lining heals.


 * Antibiotic treatment may be necessary if there is an infection.

Where to find medical care for Asherman’s syndrome?
Directions to Hospitals Treating Asherman’s syndrome

What to expect (Outlook/Prognosis)?

 * Asherman syndrome can be cured in most women with surgery, although sometimes more than one procedure will be necessary.


 * Women who are infertile because of Asherman syndrome may have a successful pregnancy after treatment.


 * Successful pregnancy depends on the severity of Asherman syndrome and the difficulty of the treatment, as well as other factors that affect fertility and pregnancy.

Possible complications

 * Complications of hysteroscopic surgery are uncommon and include bleeding, perforation of the uterus, and pelvic infection.


 * In some cases, treatment of Asherman syndrome will not cure infertility.

Prevention
Most cases of Asherman syndrome cannot be predicted or prevented.

Support groups
Asherman syndrome support group

Source
http://www.nlm.nih.gov/medlineplus/ency/article/001483.htm