33-year-old patient post-nursing amenorrhea

Asherman syndrome

Asherman syndrome is the most likely cause of amenorrhea in this patient. It is the only uterine cause of secondary amenorrhea and results from acquired scarring of the endometrial lining, usually secondary to postpartum hemorrhage or endometrial infection followed by instrumentation such as dilation and curettage.

Asherman syndrome should be suspected in a woman with secondary amenorrhea and a history of uterine infection or dilation and curettage for an obstetrical complication such as the one described in this case.

The diagnosis is suggested by the absence of a normal uterine stripe on ultrasound and the absence of withdrawal bleeding after the administration of estrogen and then progestin for several weeks. Hysteroscopic evaluation of the endometrium confirms the diagnosis. Sheehan syndrome also results in postpartum amenorrhea and can be associated with postpartum hemorrhage; however, women with this condition are often unable to lactate as a result of pituitary ischemia.

Reference:

Welt CK, Barbieri RL. Etiology, diagnosis, and treatment of secondary amenorrhea. In: Basow DS, ed. UpToDate. Waltham, MA: Wolters Kluwer Health; 2012. http://www.uptodate.com/contents/etiology-diagnosis-and-treatment-of-secondary-amenorrhea . Accessed August 7, 2012.