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. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.
Related Disorders List
Information on the following diseases can be found in the Related Disorders section of this report:
- Amenorrhea, Primary
- Pelvic Inflammatory Disease
- Stein-Leventhal Syndrome
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.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
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For information about clinical trials sponsored by private sources, contact:
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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.
March of Dimes Birth Defects Foundation
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National Women's Health Network
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Asherman's Syndrome Online Community
Genetic and Rare Diseases (GARD) Information Center
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It is possible that the title of this topic is not the name you selected. Please check the Synonyms listing to find the alternate name(s) and Disorder Subdivision(s) covered by this report
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