Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman's syndrome)

Objective

To evaluate postoperative blunt adhesiolysis after sharp adhesiolysis for the treatment of intrauterine adhesions.

Design

Retrospective analysis of 24 patients treated with primary hysteroscopic adhesiolysis followed by hormone therapy and serial flexible office hysteroscopy (Canadian Task Force Classification II-3).

Setting

University-affiliated community hospital.

Patient(s)

Twenty-four women with menstrual disorders, pain, or infertility resulting from intrauterine adhesions.

Intervention(s)

Serial, postoperative, hysteroscopic blunt adhesiolysis of recurrent synechiae.

Main Outcome Measure(s)

Restoration of normal menstrual pattern, relief of dysmenorrhea, improvement in fertility, and improvement in stage of disease.

Result(s)

Eighty-three percent of patients (20/24) presented with amenorrhea or oligomenorrhea, 67% (16/24) had either infertility or recurrent miscarriages, and 54% (13/24) presented with dysmenorrhea. Initially, 50% (12/24) had severe adhesions, 46% (11/24) moderate, and 4% (1/24) minimal disease according to the March criteria. Improvement in menstrual flow occurred in 95% (18/19) of patients, relief of dysmenorrhea occurred in 92% (12/13), and 46% (7/15) of fertility patients were actively pregnant or had delivered viable infants at the conclusion of the study. There was a 92% (22/24) improvement in disease staging over the treatment interval.

Conclusion(s)

Blunt adhesiolysis with a flexible hysteroscope is effective for maintenance of cavity patency after primary treatment of intrauterine adhesions.

Key Words: Intrauterine adhesions, Asherman's syndrome, postoperative therapy, office hysteroscopy, flexible hysteroscopy