Asherman syndrome

Asherman syndrome (named after Czech gynecologist Josef Asherman who described the pathology in 1948) is an acquired uterine pathology characterized by partial or complete obliteration of the uterine cavity and/or cervical canal by fibrous connective tissue adhesions (synechiae).

Etiology and pathophysiology

The pathogenesis is based on deep damage to the basal layer of the endometrium which hinders its cyclical regeneration. The opposing uterine walls, which lack epithelium, adhere through fibrin strands that subsequently organize into dense scars.

Main causes include: severe curettage (particularly after complicated or failed pregnancies), uterine surgeries (such as myomectomy), and severe endometritis.

A specific role is occupied by tuberculous endometritis: it causes deep destructive caseous necrosis of the basal layer, replacing it with coarse scar tissue, often leading to total cavity obliteration (“marble uterus”).

Clinical significance

The clinical picture depends on the degree of cavity obliteration and includes hypomenstrual syndrome (scanty menstruation), secondary amenorrhea (complete absence of menstruation with normal ovarian function), hematometra (accumulation of blood above the adhesion site), and uterine infertility. Tuberculosis-related Asherman syndrome has the worst prognosis for fertility restoration due to irreversible destruction of the endometrial receptor apparatus.