Toaff R, Ballas S
Fertil Steril. 1978 Oct;30(4):379-87. doi: 10.1016/s0015-0282(16)43568-5.
Traumatic damage to the endometrium (corporeal adhesions) and/or to the cervical internal os (cervical stenosis or atresia) may cause hypomenorrhea-amenorrhea, the only sign of Asherman's syndrome. We demonstrated a close correlation between severity of menstrual insufficiency and extent of corporeal adhesions. Minor adhesions in the lower part of the uterine cavity, however, may cause severe hypomenorrhea, frequently complicated by dysmenorrhea. Secondary amenorrhea may be due either to complete obliteration of the uterine cavity or to stenosis or atresia of the internal os, as proved by radiologic studies. When amenorrhea is due to stenosis or atresia of the internal os, the ovarian cycle continues but the endometrium becomes refractory to horomonal stimuli, and hematometra does not occur. Simple cervical dilatation restores menstruation within 4 to 5 weeks. The menstrual insufficiency of Asherman's syndrome, therefore, may be explained by two pathophysiology mechanisms: (1) reduction of the endometrial bleeding area and (2) trophic changes and unresponsiveness of the endometrium, perhaps caused by a visceral reflex originating in the area of the internal os.
子宫内膜创伤（宫腔粘连）和/或宫颈内口创伤（宫颈狭窄或闭锁）可能导致月经过少 - 闭经，这是阿谢曼综合征的唯一症状。我们证明了月经不足的严重程度与宫腔粘连程度之间存在密切相关性。然而，子宫腔下部的轻微粘连可能导致严重的月经过少，并常伴有痛经。继发性闭经可能是由于子宫腔完全闭塞或宫颈内口狭窄或闭锁所致，这已通过放射学研究得到证实。当闭经是由于宫颈内口狭窄或闭锁时，卵巢周期仍在继续，但子宫内膜对激素刺激变得不敏感，且不会发生子宫积血。单纯的宫颈扩张可在4至5周内恢复月经。因此，阿谢曼综合征的月经不足可能由两种病理生理机制解释：（1）子宫内膜出血面积减少；（2）子宫内膜的营养变化和无反应性，这可能是由宫颈内口区域起源的内脏反射引起的。
