Asherman's syndrome physical examination

Jump to navigation Jump to search

Asherman's syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Asherman's syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Asherman's syndrome physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Asherman's syndrome physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Asherman's syndrome physical examination

CDC on Asherman's syndrome physical examination

Asherman's syndrome physical examination in the news

Blogs on Asherman's syndrome physical examination

Directions to Hospitals Treating Asherman's syndrome

Risk calculators and risk factors for Asherman's syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Saud Khan M.D.

Overview

Asherman's syndrome is typically occult, as such, a proper history consisting of menstrual change, infertility, dysmenorrhea, history of prior pregnancies, and history of prior uterine procedures is required. Cervical probing and dilation is usually deferred for the second clinical encounter. Ultrasound and hysteroscopy are used in conjunction to form a diagnosis.

Physical Examination

In most cases, bimanual pelvic examination does not help in diagnosis. Probing of the cervix or dilation at the initial visit is also not recommended. If cervical dilation is indicated for another procedure (eg, endometrial biopsy), physicians may experience resistance from obstructive adhesions blocking entry of the instrument.

Estrogen/progestin withdrawal test was historically used, however this has fallen out of practice for diagnosing Asherman's syndrome as this test requires additional time and only delays the diagnosis. An estrogen-progestin withdrawal test is a two-month process during which the patient receives progestin alone followed by estrogen and progestin.

Ultrasound is commonly used in the initial workup. A very thin endometrium lining in a patient with amenorrhea, or other irregularities with hyperechoic regions may be suggestive of an adhesive process. Further workup using a hysteroscopy is required to confirm the diagnosis. Hysteroscopy, with lysis of adhesions as indicated, can be performed in an office or operating room setting. This is diagnostic and therapeutic, as well as decreasing the likelihood of trauma to the surrounding tissue.

Additional testing is done to rule out infective processes, especially for women from Tubercolosis endemic areas. [1]

References

  1. AAGL Elevating Gynecologic Surgery (2017). "AAGL Practice Report: Practice Guidelines on Intrauterine Adhesions Developed in Collaboration With the European Society of Gynaecological Endoscopy (ESGE)". J Minim Invasive Gynecol. 24 (5): 695–705. doi:10.1016/j.jmig.2016.11.008. PMID 28473177.