Normally Asherman’s Syndrome is a problem that are divided based on adhesions and/or fibrosis of the endometrium particularly but can also affect the myometrium. It is often associated with dilation and curettage of the intrauterine cavity. there are other terms that are being used to describe the condition and related conditions including: intrauterine adhesions (IUA), uterine/cervical atresia, traumatic uterine atrophy, sclerotic endometrium, endometrial sclerosis, and intrauterine synechiae there are many classification systems were developed to describe Asherman’s syndrome (citations to be added), some taking into account the amount of functioning residual endometrium, menstrual pattern, obstetric history and other factors which are thought to play a role in determining the prognoses. along With the advent of techniques which allow visualization of the uterus, classification systems were developed to take into account the location and severity of adhesions inside the uterus. It is used in mild cases with adhesions restricted to the cervix may present with amenorrhea and infertility, showing that symptoms alone do not necessarily reflect severity. The Other patients may not have adhesions but amenorrhea and infertility due to a sclerotic atrophic endometrium. The latter form has the worst prognosis. It is often segregated based on decrease in flow and duration of bleeding (absence of menstrual bleeding, little menstrual bleeding, or infrequent menstrual bleeding) and become infertile. The 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 is sometimes experienced and can be attributed to blockages. A research says that 88% of AS cases occur after a D&C is performed on a recently pregnant uterus, following a missed or incomplete miscarriage, birth, or during an elective termination (abortion) to remove retained products of conception.
The cavity of the uterus is lined by the endometrium. This lining has two layers, the functional layer (adjacent to the uterine cavity) which is shed during menstruation and an underlying basal layer (adjacent to the myometrium), which is necessary for regenerating the functional layer. The problem to the basal layer, typically after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or for surgical termination of pregnancy, which can lead to the development of intrauterine scars resulting in adhesions that can obliterate the cavity to varying degrees. In the extreme, the whole cavity can be scarred and occluded. the endometrium may fail to respond to estrogen even with relatively few scars.
This Asherman’s syndrome affects all equally, suggesting no underlying genetic predisposition for its development. AS can result from other pelvic surgeries including cesarean sections, removal of fibroid tumours (myomectomy) and from other causes such as IUDs, pelvic irradiation, schistosomiasis and genital tuberculosis. Chronic endometritis from genital tuberculosis is an important cause of severe intrauterine adhesions (IUA) in the developing world, and often resulting in total obliteration of the uterine cavity which is difficult to treat.
In some cases an artificial form of AS can be surgically induced by endometrial ablation in women with excessive uterine bleeding, in lieu of hysterectomy,
The Asherman syndrome is a very rare condition. In most of the cases, it affects the women who have had several dilatation and curettage (D&C) procedures. but at times severe pelvic infection unrelated to surgery may also lead to Asherman syndrome. But the Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis
intrauterine adhesions orAsherman’s Syndrome, are categorised by the formation of adhesions (scar tissue) inside the uterus and/or the cervix. The front and back walls of the uterus stick to one another in many cases and for others, only a small portion of the uterus get affected by adhesions. based on the condition of the case the adhesions can be thin or thick, spotty in location, or confluent. important attribute that helps in treatment, They are usually not vascularan.
Many of the patients with Asherman’s Syndrome have absent periods. but some have normal periods. but for Some patients they don’t get periods but feel pain at the time that their period would normally they get each month. This problem may indicate that menstruation is happening but the blood not able to exit the uterus because the cervix is blocked by adhesions. mainly recurrent miscarriage and infertility also could be the symptoms.
Even this Syndrome can affect non-pregnant uterus, which is a result from the surgical removal of fibroids and it cause the entire uterus to enlarge, stretching the blood vessels and making them susceptible to blockages when the fibroids are removed, as they inevitably shrink back to size. That area of tissue dies and a scar forms due to the lack of oxygen and nutrients.