Alternativas terapéuticas para el manejo del síndrome de Asherman
Therapeutic alternatives for the management of Asherman's syndrome
Resumen
http://www.doi.org/10.53766/GICOS/2022.07.03.10
El síndrome de Asherman representa un problema de salud, debido a que ocasiona alteraciones ginecológicas que afectan el ciclo menstrual y la función reproductiva. Actualmente, la histeroscopia utilizada para eliminar las adherencias no logra recuperar la anatomía endometrial por lo que el porcentaje de recurrencias es elevado y la tasa de embarazos es baja, por lo tanto, se necesita de métodos coadyuvantes para evitar o disminuir estas recidivas y mejorar la receptividad. El objetivo de esta revisión bibliográfica fue describir las principales alternativas terapéuticas coadyuvantes empleadas en el manejo postoperatorio de las recidivas del Síndrome de Asherman. Para ello, se realizó una búsqueda en las bases de datos Google Académico, PubMed y Springer, se encontró un total de 898 artículos, se excluyeron aquellos que tenían otras variables de estudio como: aborto, infertilidad, embarazo, los que no disponían de texto completo y aquellos cuya fecha de publicación fue antes del 2017, al final se seleccionaron 32 artículos. Resultados: los estrógenos en combinación con progesterona a dosis bajas ayudan a mejorar la función endometrial, por otro lado, el DIU con ácido hialurónico representa la mejor opción para una buena reparación endometrial. Conclusión: el uso de barreras sólidas combinadas con geles y la terapia hormonal constituye la alternativa de mayor eficacia en el tratamiento de las recidivas del síndrome de Asherman, y los avances en la terapia con células madre garantizan una recuperación total, pero aún existen limitaciones que impiden su uso.
Asherman's syndrome represents a health problem, because it causes gynecological alterations that affect the menstrual cycle and reproductive function. Currently, the hysteroscopy used to remove adhesions fails to recover the endometrial anatomy, so the percentage of recurrences is high, and the pregnancy rate is low, therefore, adjuvant methods are needed to avoid or reduce these recurrences and improve the receptivity. The objective of this bibliographic review was to describe the main adjuvant therapeutic alternatives used in the postoperative management of recurrences of Asherman's Syndrome. For this, a search was made in the Google Scholar, PubMed and Springer databases, a total of 898 articles were found, those that had other study variables such as: abortion, infertility, pregnancy, those that did not have a complete text and those whose publication date was before 2017 were excluded, at the end, 32 articles were selected. Results: estrogens in combination with progesterone at low doses help improve endometrial function, on the other hand, the IUD with hyaluronic acid represents the best option for a good endometrial repair. Conclusion: the use of solid barriers combined with gels and hormonal therapy constitutes the most effective alternative in the treatment of recurrences of Asherman's syndrome, and advances in stem cell therapy guarantee total recovery, but there are still limitations that prevent their use.
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Referencias
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DOI: https://doi.org/10.53766/GICOS
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