National Organization for Rare Disorders, Inc.
It is possible that the main title of the report Asherman's Syndrome is not the name you expected.
Asherman's syndrome is an uncommon, acquired, gynecological disorder characterized by changes in the menstrual cycle. Patients experience reduced menstrual flow, increased cramping and abdominal pain, eventual cessation of menstrual cycles (amenorrhea), and, in many instances, infertility. Most often these symptoms are the result of severe inflammation of the lining of the uterus (endometriosis) that is caused by the development of bands of scar tissue that join parts of the walls of the uterus to one another, thus reducing the volume of the uterine cavity (intrauterine adhesions and synechiae). Endometrial scarring and intrauterine adhesions may occur as a result of surgical scraping or cleaning of tissue from the uterine wall (dilatation and curettage [D and C]), infections of the endometrium (e.g., tuberculosis), or other factors.
Most patients with Asherman's syndrome present with sparse or absent menstrual blood flows. In a few instances, the menstrual cycle may be normal. In some instances, the affected individual may experience an interrupted menstrual blood flow with substantial pain.
This may occur as a result of blockage of the cervix (the neck of the uterus) by adhesions. Recurrent miscarriages and/or infertility may also be signs of this syndrome.
Asherman's syndrome can be caused by surgical scraping or cleaning of the uterine wall (dilatation and curettage, also known as D&C). Intrauterine surgery to get rid of fibroids, or repair structural defects, or related to the use of IUD birth control devices may also result in Asherman's syndrome.
Sporadic inflammation of the mucous membrane lining the uterus (endometriosis), or endometriosis caused by a tuberculosis infection or certain other infectious diseases may also be causes of Asherman's syndrome.
Symptoms of the following disorders can be similar to those of Asherman's Syndrome. Comparisons may be useful for a differential diagnosis:
Primary Amenorrhea is the absence or slowing down of menstruation for at least three months. It may be the result of a number of gynecologic problems. Most often this disorder is a result of either too much or too little hypothalamic gonadotropic-releasing hormone (GnRH, a sex cell growth hormone). Symptoms of Primary Amenorrhea may be the absence of secondary sex characteristics, incomplete or underdeveloped external genitalia and breasts, ovarian deficiency, underactive pituitary and an absence of menstruation by age 16. (For more information on this disorder, choose "Primary Amenorrhea" as your search term in the Rare Disease Database.)
In Secondary Amenorrhea, which occurs in Asherman's Syndrome, the absence of menstruation occurs in women who have previously menstruated. Menstruation ceases following scraping of the uterine wall (D&C) or acute endometritis.
Endometriosis is a prevalent gynecological condition that affects women. It is caused by an inability to shed the buildup of tissue that normally forms in the uterus (endometrium) before menstruation. This build-up of excess tissue can spread as far as the lungs, although it usually accumulates on the bowels or intestines. Symptoms of this disorder may be lower back pain, pain in the thighs or excessive pain during the menstrual cycle. (For more information on this disorder choose "Endometriosis" as your search term in the Rare Disease Database.)
Pelvic Inflammatory Disease (PID) is the infection of the fallopian tubes, cervix, uterus or ovaries. It occurs most often in young women who are sexually active. PID is transmitted by sexual intercourse, childbirth or abortion. The organism Neisseria Gonorrhoeae causes this infection in 40-60% of the patients.
Stein-Leventhal Syndrome is a rare reproductive disorder affecting young women. It is characterized by absent or abnormal menstruation, sterility, mild signs of secondary male sex characteristics, and sometimes obesity. The causes of the syndrome are not understood, but involve faulty production of reproductive hormones. Hormone therapy is often effective, but recurrences are common. (For more information on this disorder choose "Stein-Leventhal" as your search term in the Rare Disease Database.)
Unless the physician is careful, the diagnosis of Asherman's syndrome may be needlessly overlooked. A simple X-ray of the uterus with a small tube placed in the cervix is usually diagnostic. However, many physicians will, in order to save time, use a small balloon catheter placed in the uterus. The latter technique will overlook a number of cases of this syndrome. The gold standard for diagnosis uses a hysteroscope that pictures the interior of the uterus directly.
Many physicians argue against the use of lasers or other devices to remove the adhesions. These doctors claim that the use of small cutting devices is less likely to irritate the lining of the uterus or to cause infection.
Hormonal therapy is also used to encourage menstruation.
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Klein J, Sauer MV. Asherman Syndrome. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:308-09.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed.McGraw-Hill Companies. New York, NY; 1998:2106, 2108.
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1365, 1427.
Jones III H, Wentz AC, Burnett LS., eds. Novak's Textbook of Gynecology. 11th ed. William & Wilkins, Baltimore, MD; 1988:358-59.
Magos A. Hysteroscopic treatment of Asherman's syndrome. Reprod Biomed Online. 2002; Suppl 3:46-51.
Hucke J, De Bruyne F, Balan P. Hysteroscopy in infertility - diagnosis and treatment including folloposcopy. Contrib Gynecol Obstet. 2000;20:13-20.
Al-Inany H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand. 2001;80:986-93.
Yasmin H, Adeghe JH. Severe early-onset intrauterine growth restriction (IUGR) in a woman with Asherman's syndrome. J Obstet Gynaecol. 2004;24:312-14.
Davies C, Gibson M, Holt EM, et al. Amenorrhea secondary to endometrial ablation and Asherman's syndrome following uterine artery embolization. Clin Radiol. 2002;57:317-18.
Pal A, Babinszki A, Vajda G, et al. Diagnosis of Asherman's syndrome with three-dimensional ultrasound. Ultrasound Obstet Gynecol. 2000;15:341-43.
Broome JD, Vancaillie TG. Fluoroscopically guided hysteroscopic division of ahesions in severe Asherman's syndrome. Obstet Gynecol. 1999;93:1041-43.
FROM THE INTERNET
Medical Encyclopedia: Asherman's syndrome. MedlinePlus. Update date: 1/13/2003. 2pp.
Asherman's Syndrome. Last updated on August 19, 2004. 4pp.
Asherman's Syndrome. International Adhesions Society. Updated: March 2003. 3pp.
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Last Updated: 4/25/2008
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