Six months after suction evacuation for a missed abortion, a 30-year-old woman develops secondary amenorrhoea with monthly cyclical lower abdominal pain. Probing of the uterus releases dark old blood and hysteroscopy shows bands of tissue bridging the cavity. Her serum FSH and LH are normal. What is the most likely diagnosis?

• A Premature ovarian insufficiency
• B Sheehan syndrome
• C Intrauterine adhesions, Asherman syndrome ✓
• D Genital tuberculosis

Explanation

Curettage that damages the basal layer of endometrium can produce synechiae causing amenorrhoea with cyclical pain from trapped menstruation, and hysteroscopy is diagnostic. Normal gonadotropins exclude premature ovarian insufficiency, and normal pituitary function with no lactation failure excludes Sheehan syndrome, killing the two strongest distractors. Genital tuberculosis also causes adhesions but would show caseating granulomas and raised ESR rather than a direct temporal link to curettage.

Reference: DC Dutta Textbook of Gynecology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.