Restoration of Menstruation in Asherman Syndrome with Intrauterine Balloon Placement After Hysteroscopic Adhesiolysis: a Case Report

Abstract

Introduction: Asherman syndrome (AS) is characterized by intrauterine adhesions resulting from basal endometrial trauma, commonly after curettage, and is an important cause of secondary amenorrhea and infertility.

Case Presentation: A 36-year-old woman presented with secondary amenorrhea following curettage for an incomplete abortion. Hysteroscopy confirmed moderate-to-severe intrauterine adhesions (ASRM score 8) extending from the internal cervical os to the uterine corpus, supported by histopathology showing fibrous stroma and squamous metaplasia. Management included hysteroscopic adhesiolysis, intrauterine balloon catheter placement for 10 days, and sequential hormonal therapy with Cyclo-Progynova, followed by repeat hysteroscopy. Menstruation resumed 15 days after the first procedure. Due to residual adhesions, a second adhesiolysis was performed, followed by additional hormonal cycles. At follow-up, the patient achieved regular menstruation with improved uterine cavity (ASRM score 6). This case highlights that hysteroscopy remains the widely accepted technique for diagnosis and treatment, especially when non-invasive imaging is inconclusive. Moderate-to-severe adhesions often require repeated intervention. The use of an intrauterine balloon as a mechanical barrier, combined with hormonal therapy, supports endometrial regeneration and reduces recurrence risk. Despite fibrotic histopathology, restoration of menstruation suggests preserved regenerative potential of residual basal endometrium

Conclusion: A multimodal approach combining adhesiolysis, intrauterine balloon placement, hormonal therapy, and serial hysteroscopic evaluation was associated with menstrual restoration in this patient with moderate-to-severe AS.