Curriculum · Gynecology / Women's Health / Infertility / Perinatal Care / Birth Spacing
Asherman syndrome (intrauterine adhesions)
What it is
Asherman syndrome is intrauterine synechiae, that is scar tissue inside the uterus. It belongs to the outflow tract group among the causes of secondary amenorrhea, and to the acquired uterine causes of infertility beside submucosal fibroid, adenomyosis, polyp and endometritis.
Causes and risk
The risk factors are intrauterine procedures, pregnancy, inflammation, and infection. Curettage is the single item to ask about in the history, and a D&C done because products of conception remain after birth is one route in. Uterine structural abnormality of this kind, listed as septum, adhesions and fibroid, is itself a modifiable risk factor for miscarriage.
How it presents
Patients present with abnormal uterine bleeding, recurrent pregnancy loss, dysmenorrhea, and infertility, and many arrive because their periods have stopped. FSH and LH levels are usually normal. That is what sets it apart from primary ovarian insufficiency, where serum estradiol is low and FSH and LH are elevated.