Asherman's syndrome medical therapy
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Editor(s)-in-Chief: Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Canan S Fornusek, Ph.D.; Associate Editor-In-Chief: Saud Khan M.D.
Overview
Medical therapy usually follows surgical removal of fibrous bands in the uterus causing the condition. Estrogen provides stimulation for endometrial proliferation. Anti-adhesive gels may also be employed to prevent recurrence.
Medical Therapy
Hormonal therapy with synthetic or conjugated estrogen is usually prescribed following surgery to stimulate endometrial growth thereby preventing the walls of the uterus from re-adhering.
Acunzo et al found a significant effect of hyaluronic acid compared to no gel barrier for prevention of new IUA after hysteroscopic adhesiolysis. However, a large study comparing intrauterine balloon, Intrauterine contraceptive device (IUCD) and hyaluronic acid gel demonstrated that the balloon and IUCD were more effective than the gel. Fertility data was not accounted for in this analysis so long term results cannot be determined. Another retrospective cohort study compared balloon, IUCD, hyaluronic acid and controls. In this study no difference between balloon and IUCD was seen, yet these two modalities were significantly more effective than hyaluronic acid.[1]
According to the literature the only specific infection that causes Ashermans Syndrome is genital tuberculosis. There is no evidence in the literature that prophylactic antibiotics can prevent secondary intrauterine infectious complications. However, antibiotics are mandatory when infection is the cause of adhesion formation.
More studies are needed to evaluate which method of treatment is most likely to have a successful outcome. Future randomized trials are needed to prove if stem cell treatment will have a clinical role in Ashermans Syndrome.
References
- ↑ Lin XN, Zhou F, Wei ML, Yang Y, Li Y, Li TC; et al. (2015). "Randomized, controlled trial comparing the efficacy of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis". Fertil Steril. 104 (1): 235–40. doi:10.1016/j.fertnstert.2015.04.008. PMID 25936237.