🕸️ Asherman's Syndrome

🔑 Key Learning

• Caused by intrauterine adhesions following endometrial trauma.
• Classically presents with secondary amenorrhoea, infertility, or recurrent miscarriage.
• Hysteroscopy is the gold standard for diagnosis and treatment.

🧬 Pathophysiology

• Intrauterine adhesions form due to trauma to the basal layer of the endometrium.
• Common causes:
  • Dilatation and curettage (D&C), particularly post-miscarriage or postpartum
  • Endometritis
  • Uterine surgery (e.g. myomectomy)
• Adhesions may cause partial or complete obliteration of the uterine cavity → distortion of anatomy and function.

👀 Clinical Features

• Infertility
• Recurrent pregnancy loss
• Dysmenorrhoea, amenorrhoea

🧪 Investigations

• Hysteroscopy – gold standard for both diagnosis and treatment

💊 Management

• Hysteroscopic adhesiolysis – surgical division of adhesions

📝 Exam Clues & Clinchers

• Woman with history of D&C and new-onset amenorrhoea or infertility → think Asherman’s
• Hysteroscopy is the investigation and treatment of choice