Intrauterine adhesions

Abstract

Intrauterine adhesions (IUAs) are primarily an iatrogenic condition, where surgical scarring of the uterus can cause menstrual and reproductive dysfunction. When associated with hematometra through outflow obstruction, IUA can result in pain colloquially known as Asherman's syndrome. Hysteroscopy seems more accurate in identification of IUA than other modalities. Hysteroscopic adhesiolysis is the primary treatment, though there are multiple emerging approaches for reducing reformation of IUAs, including hormonal therapy, stents, hyaluronic acid, carboxymethylcellulose, and more. Postoperative outcomes largely relate to the extent of preoperative disease, where many women can successfully conceive, particularly for those with mild to moderate IUAs preoperatively. Though IUAs continue to pose a meaningful burden on affected women more than a century after they were first described, research demonstrates prognosis in IUA detection, treatment, and long-term outcomes.