• Definition: endometrial adhesions or fibrosis
• Etiology
  • Following uterine dilation or curettage (most common cause)
  • Postinflammatory (e.g., chlamydia)
• Pathophysiology: uterine dilation or curettage → endometrial basal layer damage
  • The scar tissue can disrupt the normal shedding of the uterine lining during menstruation.
• Clinical features
  • Usually asymptomatic
  • Abnormal uterine bleeding
  • Secondary amenorrhea
  • Infertility
  • Recurrent pregnancy loss
  • Periodic abdominal pain
• Diagnostics
  • Negative progesterone withdrawal test: No bleeding after progesterone cessation suggests blockage of the outflow tract.
  • Confirmatory test: hysteroscopy to directly visualize adhesions
  • Hysterosalpingography: honeycomb appearance of the uterus
• Treatment
  • Hysteroscopic resection of the adhesions
  • Treatment is only indicated if patients are symptomatic.