The prevalence of Asherman syndrome in the general population is not easy to ascertain but it can go so far as 21% in the group of women that had curettage after delivery [1]. Whereas any intrauterine damage can cause adhesions and consequent uterine problems, the majority of adhesions are associated with problems of pregnancy [2], specifically with procedures of curettage performed after deliveries and abortions [1]. The tendency for adhesions to form after repeated miscarriages or use of instrumentation in general on the postpartum uterus is also high [3] [4].

The adhesions in severe cases almost fill up the uterine cavity. The most frequent clinical manifestations are menstrual problems (hypomenorrhea and amenorrhea) and infertility or subfertility [5] [6]. Some reports note a correlation between the extent of uterine damage and the severity of menstrual complaints [1] [7]. A deficient function of the endometrium, which may be due to inadequate perfusion, hinders successful implantation and leads to infertility or repeated miscarriages [8]. Subfertility may also be caused by the adhesions blocking the free advance of the sperm [1]. Cyclical pain may result from blocked menstrual outflow, which may lead to retrograde menstruation.

• Abdominal Pain

  Patients may present with infertility, pregnancy loss, menstrual abnormalities (e.g. amenorrhea, hypomenorrhoea, dysmenorrhea) or abdominal pain 1. [radiopaedia.org]

  The result of the reduction of space within the uterus caused by the adhesions is most frequently amenorrhea (no menstruation), or reduced menstrual flow accompanied by increased cramping and abdominal pain, recurrent miscarriage and infertility. [fertilityfactor.com]

  Patients experience reduced menstrual flow, increased cramping and abdominal pain, eventual cessation of menstrual cycles (amenorrhea), and, in many instances, infertility. [rarediseases.org]

• Amenorrhea

  PATIENT(S): Twelve women with severe Asherman syndrome and amenorrhea. [ncbi.nlm.nih.gov]

  Asherman syndrome refers to a condition in which adhesions (synechiae) are present in the uterus resulting in various complaints, such as amenorrhea and infertility. The condition usually appears after an intrauterine trauma. [symptoma.com]

  Results: There were 17 subjects in all with a mean age of 28.6 years, mean parity of 4.5 and mean amenorrhea duration of 5.5 months. Sixteen were primarily referred for evaluation of amenorrhea. [pjms.com.pk]

• Secondary Amenorrhea

  A 27-year-old Zulu woman, para 1, presented with secondary amenorrhea after an uncomplicated cesarean delivery. Hormone levels were in the normal ranges. [ncbi.nlm.nih.gov]

  Asherman's syndrome secondary amenorrhea in a hormonally normal woman, caused by obliteration of the endometrial cavity by adhesions that form as a result of curettage, infection, or uterine ablation. [medical-dictionary.thefreedictionary.com]

  Symptoms - Asherman's syndrome Causes - Asherman's syndrome Prevention - Asherman's syndrome Diagnosis - Asherman's syndrome The history of a pregnancy event followed by a D&C leading to secondary amenorrhea is typical. [checkorphan.org]

  Explore these free sample topics: -- The first section of this topic is shown below -- Basics Description Asherman syndrome (AS) is the term used to describe infertility or secondary amenorrhea associated with intrauterine adhesions (IUAs) or development [unboundmedicine.com]

  Diagnosis The historical event of pregnancy followed by curettage which leads to secondary amenorrhea or hipomenorrea is typical. Hysteroscopy is the gold standard for diagnosis. [laparoscopyhospital.com]

• Oligomenorrhea

  Often, patients experience side menstrual irregularities characterized by a decrease in the rate and duration of bleeding (amenorrhea, oligomenorrhea or hipomenorrea) and become sterile. [laparoscopyhospital.com]

  Often, patients experience secondary menstrual irregularities characterized by changes in flow and duration of bleeding (amenorrhea, hypomenorrhea, or oligomenorrhea ) [ 1 ] and become infertile. [enacademic.com]

  Patients and Methods This was a hospital based descriptive study of one and half year, where patients coming to outpatient department for complaints of secondary ammenorrhoea, oligomenorrhea, or infertility were selected following all routine investigations [jpma.org.pk]

• Primary Amenorrhea

  Primary amenorrhea is when a teenage girl has reached or passed the age of 16 and still hasn’t had her first period. Most girls begin menstruating between ages 9 and 18, but 12 is the average age. [healthline.com]

A history revealing problems with infertility and menstruation will raise suspicion of Asherman syndrome. Various imaging methods are used for diagnosing the disease.

Transvaginal ultrasound, while inexpensive and available in most settings, has low sensitivity and specificity in diagnosing Asherman syndrome [9]. However, sonohysterography performed on a uterus filled with saline solution has better sensitivity and predictive capability. Three-dimensional ultrasonography is able to confirm decreased volume of the uterine cavity [10].

Hysterosalpingography, a radiologic procedure which is considered a "historical" method [1] [11], could be helpful in the diagnosis, and the radio-opaque medium used allows the patency of the tubes to be examined [12]. The presence of adhesions is indicated by sharp contours in the image, and if the inside of the uterus is completely occluded, the contrast material is unable to penetrate the uterus.

Hysteroscopy, which can be carried out in an office visit setting, is the gold standard for the diagnosis. It is the most precise method for visualization of the inside of the uterus and can show the location and shape of adhesions [11]. Office hysteroscopy for the diagnosis and treatment of relatively mild adhesions has been shown to increase the pregnancy rate in previously unresponsive women [13].

Classification and grading of cases of Asherman syndrome are problematic because there are several systems in use with different scoring criteria. When the gynecological history of the patient is taken into account in addition to the results of imaging tests, the predictive value of the classification is improved [14] [15]. Nevertheless, there is no universal agreement on which system to use [1].

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