Asherman’s Syndrome with Prolonged Copper-T Use: A Case Report

Intrauterine Adhesions (IUAs), or Asherman’s syndrome, typically result from damage to the stratum basalis of the endometrium due to intrauterine surgery, infections, or trauma such as curettage. While Copper Intrauterine Devices (IUDs) were traditionally used to prevent recurrence of such adhesions, our case report suggests they may, in rare cases, contribute to their formation. A 40-year-old Para 3 woman presented for the removal of a Copper-T IUD (380 A) inserted 13 years prior (exceeding the 10-year limit). She reported a history of hypomenorrhoea but had no prior history of uterine surgery, curettage, pelvic irradiation, or recurrent infections. Because the IUD thread was missing, a pelvic ultrasound was advised; it showed the Copper IUD in the endometrial cavity but distorted in appearance, with no other abnormality detected. Hence, hysteroscopy was planned. On hysteroscopic evaluation, we found dense, white fibrous scar tissue at the internal os, bridging the walls of the uterine cavity. After ultrasoundguided hysteroscopic adhesiolysis, we successfully identified and removed the embedded Copper-T using graspers. This case highlights that prolonged use of a Copper IUD beyond its stipulated timeframe can lead to the incidental development of IUA, likely due to chronic sterile inflammation and mechanical micro-trauma.