A 32-year-old P2L2 woman develops secondary amenorrhoea with regular cyclical lower abdominal pain six months after a dilatation and curettage done for retained products following a vaginal delivery. The uterine sound meets resistance at 4 cm. Hysteroscopy shows fibrous bands obliterating much of the endometrial cavity. What is the most likely diagnosis?

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

Explanation

Post-curettage amenorrhoea with cyclic pain and adhesion bands on hysteroscopy is Asherman syndrome, caused by intrauterine synechiae after vigorous endometrial curettage. The cyclic pain reflects trapped menstrual flow behind obstructing adhesions, a feature absent in Sheehan syndrome, which follows postpartum haemorrhage and produces hormone deficiency without pelvic pain. Genital tuberculosis can cause adhesions but the temporal link to curettage makes it unlikely here.

Reference: Dutta's Textbook of Gynecology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.