Overview

• Presence of intrauterine adhesions, following damage to the uterus.
• Usually occurs after a pregnancy-related dilatation and curettage procedure, for example in treatment of retained products of conception (ERPC).
  • Can also occur after uterine surgery (e.g. myomectomy) or several pelvic infection (e.g. endometritis).
• Adhesions form physical obstructions and distort the pelvic organs, resulting in menstruation abnormalities, infertility and recurrent miscarriages.

Making Diagnosis

Clinical Features

• Secondary amenorrhoea → cessation of menstruation in women with previously normal and regular menses.

  <aside> 💡 Primary Amenorrhoea → turner’s syndrome, congenital malformations of genital tract, CAH, imperforate hymen. Secondary Amenorrhoea (periods stop for 3-6 months when previously normal) → hypothalamic amenorrhoea (eg. secondary stress, excessive exercise), PCOS, hyperprolactinaemia, POF, thyrotoxicosis, sheehan’s syndrome, asherman’s syndrome.

  </aside>

• Lighter periods.

• Dysmenorrhoea (painful periods).

• Subfertility.

Investigations

• Hysteroscopy → gold standard, and can involve dissection and treatment of the adhesions.
• Hysterosalpingography → contrast is injected into the uterus and imaged with x-rays.
• Sonohysterography → where the uterus is filled with fluid and a pelvic ultrasound is performed.
• MRI scan.

Management Plan