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.

• Infertility

  Abstract Mullerian duct malformations were found in 8% and Asherman syndrome in 4.8% of 537 infertile women undergoing hysterosalpingogram and/or hysteroscopy among 840 consecutive infertile couples evaluated. [ncbi.nlm.nih.gov]

  Result: A total of 20 patients were included in this study, the median age was 26 years,65% had presented with scanty menses with secondary infertility,20% with secondary ammenorrhoea,and 15% with primary infertility alone. [jpma.org.pk]

  In addition to surgery, the treatment of Asherman’s syndrome involves appropriate postoperative management to prevent additional causes of infertility. [wjgnet.com]

  A deficient function of the endometrium, which may be due to inadequate perfusion, hinders successful implantation and leads to infertility or repeated miscarriages. [symptoma.com]

  For couples and individuals struggling to conceive, our North Dallas fertility center team provides advanced infertility care for area patients. Dr. Douglas can address common causes of infertility, including intrauterine scarring. [ivfplano.com]

• Surgical Procedure

  Severe bands may be detrimental to the implantation of the embryo and may require repeated surgical procedures. [conceptfertility.co.uk]

  Other surgical procedures involving the uterus, or a manual removal of the placenta after birth can also cause Asherman's. [ic.steadyhealth.com]

  Consider the Risk of Infection Talk to your doctor about the risk of infection due to surgical procedures performed after miscarriage. [natural-fertility-info.com]

  The comprehensive therapeutic plan for the four women included (1) preoperative office hysteroscopy to confirm the diagnosis and evaluate the severity of disease; (2) the use of ultrasound-guided intraoperative abdominal procedures during the surgical [ncbi.nlm.nih.gov]

• Fever

  Details on the case of a 26-year-old female who experienced fever and chills after placement of laminaria tent in preparation for a planned abortion; Complications of using laminaria tents; Discussion on sterilizing laminaria tents. [connection.ebscohost.com]

  Most commonly, women presented with fever, cough and breathlessness. Out of 70 patients 63(90%) women had cough, 62(88%) had fever and 42(62%) had breathlessness. Other symptoms like chest pain, diarrhoea, sore throat and headache were less common. [dokodoc.com]

• Abdominal Pain

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

  The prevalence ranges from 1.73% to 40%, and the symptoms include hypomenorrhea, amenorrhea, and periodic lower quadrant abdominal pain. [atm.amegroups.com]

  This may be due to its unique age of presentation, its inherent somatic and cognitive developmental issues, or the physiology of abdominal pain itself. [pedsinreview.aappublications.org]

• Nausea

  After the laparoscopy for infertility procedure about 3% of patients there may be some nausea, discomfort and shoulder tip pain, due to the gas that was injected into the abdomen. The discomfort usually lasts not more than 24-48 hours. [fertilityclinicmumbai.com]

  Omeo She Drops: Indications: It is a specialized formula designed for painful menses accompanied by backache, nausea and vomiting. It has antispasmodic properties and is hence given in the form of drops. Ingredients: Cal. [bjainpharma.com]

  Nausea. Infertility: Intra-abdominal adhesive disease is responsible for up to 15-20% of all cases of infertility. Small bowel obstruction: 54% to 74% of small bowel obstruction cases are caused by adhesions. [britishfibroidtrust.org.uk]

  In children up to 6 years old, PU can initially present as nausea and vomiting, but hematemesis is the most common symptom, although it is difficult to establish the symptomatology. [jped.com.br]

  In children, injuries often occur in the stomach, as a single lesion, but they frequently develop as multiple, small and bleeding erosions.75 In children up to 6 years old, PU can initially present as nausea and vomiting, but hematemesis is the most common [scielo.br]

• Vomiting

  Omeo She Drops: Indications: It is a specialized formula designed for painful menses accompanied by backache, nausea and vomiting. It has antispasmodic properties and is hence given in the form of drops. Ingredients: Cal. [bjainpharma.com]

  In children up to 6 years old, PU can initially present as nausea and vomiting, but hematemesis is the most common symptom, although it is difficult to establish the symptomatology. [jped.com.br]

  In this age group, the most common symptoms include vomiting and bleeding, the latter of which is characterized either by hematemesis or melena.75 Older children and adolescents have similar symptoms to those of adults. [scielo.br]

• Melena

  In this age group, the most common symptoms include vomiting and bleeding, the latter of which is characterized either by hematemesis or melena. Older children and adolescents have similar symptoms to those of adults. [jped.com.br]

  In this age group, the most common symptoms include vomiting and bleeding, the latter of which is characterized either by hematemesis or melena.75 Older children and adolescents have similar symptoms to those of adults. [scielo.br]

• Withdrawn

  The overall status of rare disease trials shows a proportionately larger number have been terminated, withdrawn or suspended. [ojrd.biomedcentral.com]

• Confusion

  Abstract RAP offers a complex and often confusing array of symptoms and diagnostic possibilities. This may be due to its unique age of presentation, its inherent somatic and cognitive developmental issues, or the physiology of abdominal pain itself. [pedsinreview.aappublications.org]

  Miscarriage Placenta previa Placenta increta Bleeding Stillbirth Common Questions: A diagnosis of Asherman's syndrome can be frightening and confusing. [tupbebekmerkezi.net]

  West The latest thinking is different from the latest evidence, I’m afraid to say, because there’s a lot of confusion out there. [bbc.co.uk]

• Amenorrhea

  Asherman’s Syndrome: Diagnosis and Treatment at Antai Intrauterine adhesions causing amenorrhea after curettage were first described by Fritsch in 1894. [antaihospitals.com]

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

  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]

  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]

• Cesarean Section

  Regarding the described patient, we deliberated whether her baby should be delivered vaginally or by cesarean section. [wjgnet.com]

  All the women (100%, 4/4) conceived successfully (three undergoing IVF & ET, and one had a spontaneous pregnancy), but only two patients had a term pregnancy with cesarean section (one placenta previa and the other placental abruption), contributing to [ncbi.nlm.nih.gov]

  In most cases, however, this condition occurs as a result of surgery involving the uterus, including: Dilation and curettage Dilation and evacuation Cesarean section Treatment for fibroid tumors in the uterus When the uterus is traumatized, whether by [pregnancycorner.com]

• Secondary Amenorrhea

  amenorrhea in study group. [medical-dictionary.thefreedictionary.com]

  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]

  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]

  Secondary amenorrhea is when a woman has stopped menstruating for at least three months. This is the more common form of amenorrhea. In most cases, both types can be treated effectively. [healthline.com]

  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]

• 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

  You should see your doctor if you’re experiencing amenorrhea. The underlying cause of your missed periods may require treatment. The two types of amenorrhea are referred to as primary and secondary. [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].

Then we can decide on the ideal treatment. Traditionally, treatment has been performed through hysteroscopy by selecting the adhesions and trying to avoid them from reappearing with the insertion of intrauterine devices. [institutobernabeu.com]

Only cases with AS, which imply pain, bleeding disorders or impaired fertility needs treatment. [antaihospitals.com]

Close antenatal surveillance and monitoring are necessary for women who conceive after treatment. [ncbi.nlm.nih.gov]

Management and treatment of Asherman syndrome The treatment strategy of AS could be summarized in four main steps: 1. Treatment (Dilatation and curettage, hysteroscopy, hysterotomy) 2. [rbej.biomedcentral.com]

The diagnostic hysteroscopy will allow us to clearly see the adhesions, the degree to which the cavity is affected, the quality of the endometrium, the tubal ostia and the possibilities of real treatment and a prognosis adapted to the severity of the [institutobernabeu.com]

CONCLUSION(S): The management of moderate to severe disease still poses a challenge, and the prognosis of severe disease remains poor. Close antenatal surveillance and monitoring are necessary for women who conceive after treatment. [ncbi.nlm.nih.gov]

Prevalence Prevalence has been cited as 0.3% incidental finding in women undergoing intrauterine device placement without gynecologic symptoms ( 1 ) 21.5% in women who have undergone postpartum curettage ( 1 ) Etiology and Pathophysiology The etiology [unboundmedicine.com]

MAIN OUTCOME MEASURE(S): The etiology, pathology, symptomatology, diagnosis, treatment, and reproductive outcomes were analyzed. [ncbi.nlm.nih.gov]

Spontaneous abortion and recurrent pregnancy loss: etiology, diagnosis, treatment. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 16. Simpson JL, Jauniaux ERM. [mountsinai.org]

New York, New York, USA c Departments of Social and Behavioral Sciences, Harvard School of Public Health, Cambrige, Massachusetts, USA d Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School [tandfonline.com]

Asherman's syndrome Microchapters Home Patient Information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Asherman's syndrome from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History [wikidoc.org]

Epidemiology Incidence As intrauterine adhesive disease is rare and generally asymptomatic, true incidence and prevalence is difficult to measure. [unboundmedicine.com]

Epidemiology The prevalence of PU is difficult to estimate, due to the subjective nature of its symptoms and also because it is frequently mistaken for other dyspeptic disorders. [jped.com.br]

In the developing world, it may also occur due to infections from schistosomiasis or tuberculosis(genital).[5] Epidemiology Asherman syndrome may go unrecognized in women who are not trying to conceive since they may not recognize or be concerned with [ncbi.nlm.nih.gov]

Asherman's syndrome Microchapters Home Patient Information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Asherman's syndrome from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History [wikidoc.org]

Prevalence Prevalence has been cited as 0.3% incidental finding in women undergoing intrauterine device placement without gynecologic symptoms ( 1 ) 21.5% in women who have undergone postpartum curettage ( 1 ) Etiology and Pathophysiology The etiology [unboundmedicine.com]

Pathophysiology Asherman syndrome occurs when trauma to or removal of the basal layer of endometrium in opposing areas within the uterine cavity. [ncbi.nlm.nih.gov]

Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility 2012; 98(3), 511–519. https://doi.org/10.1016/j.fertnstert.2012.06.029 Conforti A, Alviggi C, Mollo A, De Placido G and Magos A. [rarediseases.org]

J Pediatr (Rio J). 2006;82(5):325-34: Peptic ulcer, etiology, pathophysiology, diagnosis, Helicobacter pylori, children, adolescents. [jped.com.br]

[…] adhesions), and prevent the uterus from rotating. [wjgnet.com]

A common pharmacological method for preventing reformation of adhesions is sequential hormonal therapy with estrogen followed by a progestin to stimulate endometrial growth and prevent opposing walls from fusing together.[38] However, there have been [en.wikipedia.org]

[…] immediate evacuation following fetal death may prevent IUA. [enacademic.com]

A common method for pharmacological prevention of adhesions is reforming sequential hormonal therapy with estrogen followed by progestin to stimulate endometrial growth and prevent opposing walls (1996) merge Roge. [laparoscopyhospital.com]

1. Deans R, Abbott J. Review of intrauterine adhesions. J Minim Invasive Gynecol. 2010;17(5):555-569.
2. Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol.1996;65:109-113.
3. Kodaman PH, Arici A. Intra-uterine adhesions and fertility outcome: how to optimize success? Curr Opin Obstet Gynecol. 2007;19:207–214.
4. Westendorp ICD, Ankum WM, Mol B, Vonk J. Prevalence of Asher- man’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod. 1998;13:3347–3350.
5. Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated ap praisal. Fertil Steril. 1982;37:593–610.
6. Klein SM, Garcia C-R. Asherman’s syndrome: a critique and current review. Fertil Steril 1973;24:722–735.
7. Toaff R, Ballas S. Traumatic hypomenorrhea-amenorrhea (Asherman's syndrome). Fertil Steril. 1978;30(4):379-387.
8. Polishuk WZ, Siew FP, Gordon R, Lebenshart P. Vascular changes in traumatic amenorrhea and hypomenorrhea. Int J Fertil. 1977;22:189–192.
9. Salle B, Gaucherand P, de Saint Hilaire P, Rudigoz RC. Transvaginal sonohysterographic evaluation of intrauterine adhesions. J Clin Ultrasound.1999;27(3):131-134.
10. Weinraub Z, Maymon R, Shulman A, et al. Three-dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology. Ultrasound Obstet Gynecol. 1996;8(4):277-282
11. Magos A. Hysteroscopic treatment of Asherman's syndrome. Reprod Biomed Online.2002;4 Suppl 3:46-51.
12. Yu D, Wong YM, Cheong Y, Xia E, Li TC. Asherman syndrome--one century later. Fertil Steril. 2008;89(4):759-779.
13. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. RBM Online 2004;8:590–594.
14. Nasr AL, Al-Inany HG, Thabet SM, Aboulghar M. A clinicohysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Invest 2000;50:178 –181.
15. Fedele L, Bianchi S, Frontino G. Septums and synechiae: approaches to surgical correction. Clin Obstet Gynecol. 2006;49(4):767-788.