Asherman

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Introduction

• Ashermans symdrome occure after trauma to the
  basailis layer of the endomtrium generally after
  endometrial currettage. ( Fritsch H 1894)
• Granulation tissue on either side of the
  endometrial cavity can fuse to from tissue
  gridge.
• Amenorrhea ,with or without severe dysmenorrhea,
  oligomenorrhea, infertility or recurrent
  miscarriage, hematometrial.

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• After hysteroscopic adhesiolysis normal
  menstruation 88.2.
• Currently treatment sharp hysteroscopic
  adhesiolysis and a course of oral estrogen with
  subsequent P.
• Question ideal dosing regimen or length of
  estrogen ?
• IUDs controversy
• During postoperative 2nd look office
  hysteropsies a gradual progression of recurrent
  adhesions over time.

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Materials and methods

• 2003-2005, 25 women
• Sharp hysteropsic adhesiolysis under GA and
  sonography
• 5.5mm 0D rigid hysteroscopy
• 25 days of conjugated estrogens (2.5mm) and 5
  days of combined conjugated estrogens/MPA(2.5/10mg
  )
• Serial postoperative office hysteroscopy 3.5mm
  flexible hysteroscopy to perform blunt
  adhesiolysis. (2-3 weeks later until minal or no
  disease)

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Result

• 95 (18/19) nomral menses after treatment
  (plt0.0001)
• 92(12/13) relief dysmenorrhea (p0.0002)
• 2nd look
• 92(22/24) improve in the stage
• 75 (18/24) minimal to no disease
• 58 (6/12) severe disease had minimal to no
  disease.

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