” She was not able to conceive 10 years after her marriage. She has a scanty menstrual flow for 12 years prior to presentation to the clinic. ”

Emobileclinic Patient’s corner

She was not able to conceive 10 years after her marriage. She has a scanty menstrual flow for 12 years prior to presentation to the clinic. She usually spotted for 2 days without any need to use perineal pad due to the scantiness of the menses unlike before when she used to menstrate for 5 days with good menstrual flow. The problem started about three months following voluntary termination of pregnancy which she had about 13 years ago.

The procedure was done at 12 weeks gestational age and it was done by the proprietor of a drug store near her house. The method of termination was by dilatation and Curettge and the procedure was done at the drug store. The procedure lasted for about 1hour and there was no history of excessive bleeding per vaginam afterwards. However, she had prolonged passage of foul smelling purulent vaginal discharge for about 4 weeks after the procedure with associated fever. These were treated by some capsules prescribed by the drug store owner. Her menses resumed 10weeks after the procedure and it has been gradually reducing in quantity since then.

There was associated inability to conceive since then despite coital frequency of 3-4 times per week. No history of neck swelling, weight loss or excessive weight gain nor heat or cold intolerance. No history of any other surgical procedure in the couple. Since on set of the symptoms, she had been to various herbal homes and later private Hospitals. She was given drugs which include clomiphen but no improvement. There after she had two sessions of adhesiolysis and Intrauterine Device Insertion done followed by some drugs ;the last procedure was about 2 years ago but still the menses did not improve thus necessitating her presentation. She attained menarche at 12 years and used to menstruate for 5 days in a regular 30 days cycle before the onset of symptoms.

There was no history of dysmenorrhoea, she has not used contraceptive before. She has had 2 previous terminations of pregnancy at 8 weeks in 1993 and 12 weeks in 1997.
After all investigations, it was discovered she had secondary infertility with hypomenorrhoea from Asherman Syndrome. The condition was explained to her and she was counselled for hysteroscopic adhesiolysis and she agreed.

What is intrauterine adhesions or Asherman Syndrome?

What are the treatments?