Asherman syndrome—the development of symptomatic intrauterine synechiae.
| Risk factors | • Infection (eg, septic abortion, endometritis) • Intrauterine surgery (eg, curettage, myomectomy) | | --- | --- | | Clinical features | • Abnormal uterine bleeding • Amenorrhea • Infertility • Cyclic pelvic pain • Recurrent pregnancy loss | | Evaluation | • Hysteroscopy for diagnosis and treatment via lysis of adhesions. |
intrauterine surgery →risk of damage to the endometrial basalis layer, which creates an inflamed, denuded endometrium that causes the uterus to adhere to itself, resulting in obliteration of the uterine cavity.
<aside> 💡 It occurs most often after suction and sharp curettage for delivery complications (eg, postpartum hemorrhage, endometritis). Because the postpartum uterus is soft and enlarged, curettage might be unintentionally aggressive.
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The lack of endometrium results in the development of light menses, secondary amenorrhea, infertility (due to lack of implantation), and a negative progesterone withdrawal test (despite normal estrogen and progesterone levels).
<aside> 💡 During uterine curettage, the endometrial basalis (ie, the regenerative layer of the endometrium) can be injured; therefore, endometrial overgrowth (ie, endometrial hyperplasia) is unlikely.
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Some patients may have cyclic pelvic pain if the endometrial cavity is not totally obliterated due to small pockets of obstructed, proliferative endometrium.