Hysteroscopic treatment of Asherman's syndrome

Although Asherman's syndrome (the presence of adhesions inside the cervical canal or uterine cavity) is relatively uncommon in the general population, it can be the cause of menstrual irregularity and subfertility in high risk women. The diagnosis is usually confirmed by hysterosalpinography, and more recently by hysteroscopy. Hysteroscopy has also become accepted as the optimum route of surgery, the aims being to restore the size and shape of the uterine cavity, normal endometrial function and fertility. Treatment can range from simple cervical dilatation in the case of cervical stenosis but an intact uterine cavity, to extensive adhesiolysis of dense intrauterine adhesions using scissors or electro- or laser energy. Patients in whom the uterine fundus is completely obscured, and those with a greatly narrowed, fibrotic cavity present the greatest therapeutic challenge. Several techniques have described for these difficult cases, but outcome is far worse than in patients with mild, endometrial-type adhesions. Non-hysteroscopic techniques area also beginning to be developed, but whether they will replace the current 'gold' standard of hysteroscopy remains to be seen.