Hysteroscopic adhesiolysis for Asherman's syndrome
Adhesions
inside the uterine cavity are medically referred to as Asherman's syndrome after
the gynaecologist who described the condition in 1948. Although it is not a common
condition, the widespread use of hysteroscopy to investigate the uterine cavity has
meant that many more cases are now being diagnosed. In mild cases, the adhesions
are flimsy and only involve a small part of the uterine cavity; in severe cases,
the adhesions are dense and can affect the entire cavity with absent endometrium
(lining of the womb). In other cases, Asherman's syndrome is characterised by stenosis
(extremel narrowing) of the cervix. The adhesions are thought to result from a combination
of trauma and infection insider the womb, typically after a pregnancy (e.g. retained
products requiring a D&C).
Intra-uterine adhesions can be asymptomatic and of little consequence, but more severe cases can result in scanty periods (oligomenorrhoea) or even absent periods (amenorrhoea). Cyclical pain, in time with the menstrual cycle, is often a feature. Inability to conceive is a common sequel. Diagnosis is usually made by hysteroscopy or hysterosalpinography (X-ray).
Laparotomy and division of the intra-uterine adhesions used to be the treatment in the past. Now, the adhesions can be divided hysteroscopically thereby avoiding the problems associated with open surgery. A coil (intra-uterine contraceptive device) is sometimes inserted temporarily into the uterus in an attempt to reduce recurrence of the adhesions. Hysteroscopic adhesiolysis sometimes has to be repeated, and it is usual to check the cavity after few months hysteroscopically. The success of surgery is proportional to the severity of the adhesions being treated, and is less good when the adhesions are extensive.