Asherman’s Syndrome and Chronic Pain

Asherman’s Syndrome and Chronic Pain

Asherman’s Syndrome and Chronic Pain remains a terrible situation for many women.

Miscarriage is the commonest complication of pregnancy affecting 15% of clinically recognized pregnancies. Some 5% of women will experience two or more miscarriages during their lifetime. Conservative or pharmacological management of miscarriage with misoprostol represents a less-invasive therapeutic option since ~50% of cases evacuate within 2 weeks of diagnosis (Wieringa-De Waard et al., 2002). When successful, it is a cost-effective strategy with an insignificant rate of adhesions (Hooker et al., 2013).

However, sadly most miscarriages are still treated by D&C (Hooker et al., 2016).

Trauma from procedures such as curettage is typically the cause of adhesions (Schenker and Margalioth, 1982; Yu et al., 2008; Panayotidis et al., 2009; Conforti et al., 2013). These procedures cause damage to the basalis layer of the endometrium and promote adhesions. In 15–20% of patients receiving curettage due to an induced or spontaneous abortion and 21–40% with post-partum curettage develop adhesions (Hooker et al., 2013; Gilman et al., 2016).

This rate decreases to 1.6% after diagnostic curettage in gynecological conditions and 1.3% after abdominal myomectomy (Deans and Abbott, 2010).

Women with repeated curettages as well as women with large uteri or multiple pregnancies show an increased risks of adhesions (Gilman et al., 2016). Further, women with two or more miscarriages show an increased risk of adhesions (Hooker et al., 2013).