The syndrome of Asherman is stipulated by the presence of intrauterine permanent adherence, which erases or entirely the uterus cavity partially. Most commonly, intrauterine adhesions occur after a dilatation and curettage that was performed because of a miscarriage or because of retained placenta with or without hemorrhage after a delivery. Although curettage can cause this condition, it is more likely after uterine surgery, such as myomectomy. In these cases the endometrium, or at least its basal layer, has been removed or destroyed. In rare cases, other infections or radium insertion into the uterus for the treatment of gynecologic cancers can lead to Asherman's Syndrome. Asherman's can result in all of the above circumstances. It affects women of all races and ages as there is no underlying predisposition or genetic basis to its development.
Most of the patients with Asherman have scarce or absentee periods but what has normal periods. The adherence sometimes also occurs in other situations, like after election failure, after cesarean section, after uterus surgery, or as a result of basin tuberculosis. Some patients have no periods but feel pain at the time each month that their period would normally arrive. This pain may indicate that menstruation is occuring but the blood cannot exit the uterus because the cervix is blocked by adhesions. These infections are rare in the United States, and uterine complications such as Asherman syndrome related to these infections are even less common. Depending on the degree of severity, Asherman's syndrome may result in infertility, repeated miscarriages, pain from trapped blood, and high risk pregnancies. There is evidence that left untreated, the obstruction of menstrual flow resulting from scarring can lead to endometriosis.
The adhesions may cause amenorrhea (lack of menstrual periods), repeated miscarriages, and infertility. Reduced or absent menstrual flow,especially after a pregnancy and delivery, a miscarriage or termination of pregnancy or nown elvic infection is the most common ymptom. There is a variant of Asherman's Syndrome that is more difficult to treat. This condition is called a haematometra and is like a large bruise inside the uterus. Recurrent miscarriage and infertility could also be considered as symptoms. Complications of hysteroscopic surgery are uncommon and include bleeding, perforation of the uterus, and pelvic infection. In some cases, treatment of Asherman syndrome will not cure infertility. An artificial form of Asherman's syndrome can be surgically induced by endometrial ablation in women with excessive uterine bleeding, in lieu of hysterectomy.
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