Asherman's syndrome pathophysiology
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Editor(s)-in-Chief: Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Canan S Fornusek, Ph.D.; Associate Editor-In-Chief: Saud Khan M.D.
Overview
Asherman syndrome most often is the result of vigorous scraping and damage to the basal layer of the endometrium during a dilation and curettage, which may be done for a variety of reasons. It may also occur after delivery, especially if there is uncontrolled hemorrhage, or after the elective termination of a pregnancy. Less often, it is due to sampling for endometrial cancer, or removal of endometrial polyps. It may also occur after surgery to remove uterine fibroids.
Pathophysiology
The cavity of the uterus is lined by the endometrium. This lining is composed of two layers, the functional layer which is shed during menstruation and an underlying basal layer which is necessary for regenerating the functional layer. Trauma to the basal layer, typically after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or for elective abortion triggers inflammation that allows adhesive bands to form from one side of the cavity to the other. The risk of developing Asherman syndrome is increased if during pregnancy, the placenta tissue burrows below the basal layer of the endometrium. The extent of the adhesions defines whether the case is mild, moderate, or severe.
The adhesions can be thin or thick, spotty in location, or confluent. The adhesive bands are usually not vascular, an important consideration when discussing treatment options. In extreme cases, the whole cavity becomes scarred and occluded. Even with relatively few scars, the endometrium may fail to respond to estrogens and rests.
Often, patients experience secondary menstrual irregularities characterized by changes in flow and duration of bleeding (amenorrhea, hypomenorrhea, or oligomenorrhea) [1] and may develop recurrent pregnancy loss or infertility. Menstrual anomalies are often but not always correlated with severity: adhesions restricted to only the cervix or lower uterus may block menstruation. Pain during menstruation and ovulation are also sometimes experienced, and can be attributed to blockages.[2]
References
- ↑ Klein SM, Garcia C-R (1973). "Asherman's syndrome: a critique and current review". Fertility and Sterility. 24 (9): 722–735. PMID 4725610.
- ↑ Dreisler E, Kjer JJ (2019). "Asherman's syndrome: current perspectives on diagnosis and management". Int J Womens Health. 11: 191–198. doi:10.2147/IJWH.S165474. PMC 6430995. PMID 30936754.