Symptoms and Causes of Asherman's Syndrome

Symptoms

Do you experience or have a history of any of the following?

  • Menstrual changes: sudden reduction in menstrual flow or absence of menstruation, a lot more brown blood/less red blood. Note: a few sufferers don't notice menstrual changes.
  • Pain or cramping at the time of menstruation with little or no blood (pain resulting from outflow obstruction)
  • Endometriosis: this could result from backflow of blood caused by AS.
  • Unexplained infertility (primary or secondary)
  • Repeated miscarriage which is unexplained.
  • Invasive placenta (eg. Placenta accreta, placenta percreta, placenta increta) in a past pregnancy could possibly indicate AS.

Causes

Do you have a past history of uterine surgery?

Examples:

  • D&C (in the presence or absence of infection) for any reason including:
    • miscarriage (missed or incomplete)
    • retained postpartum placenta
    • postpartum hemorrhaging
    • elective abortion/termination of pregnancy
    • endometrial biopsy
    • fibroid removal
    • treatment of excessive uterine bleeding
  • Hysteroscopic myomectomy
  • C-section
  • Uterine artery embolization
  • Endometrial ablation (This is the intentional creation of Asherman's Syndrome to treat excessive uterine bleeding.)

Other Non-surgical Causes

Have you ever had the following?

  • Manual removal of placenta
  • Uterine packing (filling the uterus with gauze; sometimes used to control postpartum hemorrhaging)
  • Pelvic irradiation (cancer treatment)
  • Caustic abortifacients (douching with a corrosive chemical to induce an abortion)
  • Endometrial tuberculosis

Diagnostic Tests and Procedures

Have you tested the following?

  • Blood tests: Estrogen, LH, progesterone, FSH, thyroid, prolactin to rule out hormonal problems affecting ovulation. Some women may not want to jump into hysteroscopy or HSG, which are not without some risks.
  • Imaging:
    • Ultrasound to measure endometrial thickness at ovulation and to check normal follicle development
    • Sonohysterography (SHG) or hysterosalpingogram (HSG (these procedures are not as accurate as hysteroscopy, but will confirm patency of tubes if infertility is a problem)
  • Other: Some doctors suggest a hormone challenge test but this can be a waste of time if blood tests are normal. It just gives pain for women whose periods are blocked by Asherman’s Syndrome.
  • Gold standard for diagnosis: diagnostic hysteroscopy

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