Asherman syndrome

Exam relevance: in 2 of 197 board exam reports · rank 144

Specialty
Gynaecology · Uterus & endometrium
Images
Ultrasound 2 · Endoscopy & gross 2 · Histology & cytology 1
Exam relevance
2 of 197 reports · rank 144
In the app
1 flashcards · GynFuchs
Last updated
10/2026 · Dr. Pascal Bafteh
Contents
  1. Images (5)
  2. Definition
  3. Classification
  4. Occurrence & epidemiology
  5. Aetiopathogenesis
  6. Clinical features
  7. Diagnosis
  8. Keep learning in the app
  9. Further reading (selection)
  10. Cross-references

Images (5)

Asherman syndrome – Ultrasound: Transvaginal ultrasound with power Doppler: endometrial polyp with a single feeder vesselUltrasound
Transvaginal ultrasound with power Doppler: endometrial polyp with a single feeder vesselImage: Wong M, Thanatsis N, Nardelli F, Amin T, Jurkovic D – Diagnostics 11(6):1094 (2021) · CC BY 4.0 · Source · cropped
Asherman syndrome – Endoscopy & gross: Hysteroscopy: large endometrial polyp in a postmenopausal patientEndoscopy & gross
Hysteroscopy: large endometrial polyp in a postmenopausal patientImage: Wang D, Wang L, Zhou N, Fang Y – Frontiers in Medicine 13:1821347 (2026) · CC BY 4.0 · Source · cropped
Asherman syndrome – Histology & cytology: Histology (H&E) of an endometrial polypHistology & cytology
Histology (H&E) of an endometrial polypImage: Wang D, Wang L, Zhou N, Fang Y – Frontiers in Medicine 13:1821347 (2026) · CC BY 4.0 · Source · cropped
Asherman syndrome – Ultrasound: Transvaginal ultrasound: circumscribed, cystic mass, clearly demarcated from the myometrium — polypUltrasound
Transvaginal ultrasound: circumscribed, cystic mass, clearly demarcated from the myometrium — polypImage: Yan L, Sun J, Yang S, Wang D, Zuo X, Zhang M, Zhang C, Zhang T, Jia H – Frontiers in Oncology 16:1682386 (2026) · CC BY 4.0 · Source · cropped
Asherman syndrome – Endoscopy & gross: Hysteroscopy: dense synechia between the anterior and posterior walls — Asherman's syndromeEndoscopy & gross
Hysteroscopy: dense synechia between the anterior and posterior walls — Asherman's syndromeImage: Johnson ME, Roura-Monllor JA, Elwood AD, Steiner AZ, Morse JE. (Case reports in women's health 2026) · CC BY 4.0 · Source · cropped
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Definition

  • Asherman syndrome denotes intrauterine adhesions arising after injury that destroys the basal layer of the endometrium.
  • The spectrum ranges from thin strands of tissue in minimal disease to complete obliteration of the cavity in severe disease.

Classification

  • Classification systems describe the location and severity of the adhesions; symptoms alone do not reflect severity.

Occurrence & epidemiology

Epidemiology

  • In some studies the risk rose with the number of D&C procedures, from 16% after one to 32% after three or more.

Aetiopathogenesis

Aetiology

  • The commonest cause is injury to the basal layer by D&C after miscarriage, birth or termination; pregnancy-related intrauterine instrumentation precedes up to 91% of cases.
  • Other causes are intrauterine devices and pelvic infections such as schistosomiasis and genital tuberculosis.

Clinical features

Clinical features and diagnosis

  • Clinically, it presents as hypo-/amenorrhoea, cyclical pain, infertility.
  • It is diagnosed hysteroscopy, supplemented by hydrosonography/HSG.
  • Leading symptoms are reduced or absent menstruation, cyclical pelvic pain and reproductive disorders such as infertility and recurrent pregnancy loss.
  • Cyclical pain arises when menstrual blood cannot leave the uterus because the cervix is blocked by adhesions.
  • Later pregnancies show more placental attachment disorders as well as fetal growth restriction and fetal anomalies.

Diagnosis

  • Hysterosalpingography, sonohysterography and ultrasound are used; hysteroscopy is regarded as the gold standard.
  • Hysterosalpingography typically shows irregular, angulated, immobile filling defects.
  • Sonohysterography and hysterosalpingography reached a sensitivity of 75% in one study; ultrasound alone is not reliable.

Keep learning in the app

In the GynFuchs app you can learn Asherman syndrome with flashcards, exam questions and image tasks (colposcopy, ultrasound, CTG) – free, in your browser or as an app.

In the app: 1 flashcards on this topic

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Further reading (selection)

  1. The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature (BMC Pregnancy Childbirth 2022, PubMed Central)
  2. Hysterosalpingography finding in intra uterine adhesion (asherman' s syndrome): a pictorial essay (Int J Fertil Steril 2013, PubMed Central)
  3. DocCheck Flexikon, Endometriumpolyp

Cross-references

More topics: Uterus & endometrium

Note: Learning content from the GynFuchs app (flashcards, exam questions, image cases) for medical education – not a treatment recommendation and no substitute for diagnosis or treatment decisions in individual cases. Treatment and management are deliberately not covered on this page.