A 30-year-old woman has secondary amenorrhea following evacuation of a retained placenta after her third delivery. She had heavy postpartum bleeding requiring curettage. Endometrial biopsy shows fibrosis with few glands. Hysteroscopy reveals extensive intrauterine adhesions. What is the definitive treatment?

• A Hysteroscopic adhesiolysis with post-operative estrogen ✓
• B High-dose estrogen therapy alone
• C Intrauterine device insertion alone
• D Surrogacy

Explanation

Asherman syndrome (intrauterine adhesions) is treated with hysteroscopic adhesiolysis, followed by high-dose estrogen to regenerate the endometrium. An intrauterine balloon or IUD may be placed to prevent re-adhesion. Estrogen alone cannot break existing adhesions. Prognosis depends on adhesion severity; severe cases may have persistent subfertility.

Reference: Te Linde's Operative Gynecology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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