What symptoms occur when cervical adhesions prevent menstrual blood from flowing out?

Cervical adhesions—also known as cervical stenosis or Asherman syndrome when involving intrauterine scarring—can obstruct menstrual outflow, leading to a condition called cryptomenorrhea. Common symptoms include secondary amenorrhea (absence of menstruation after previously having regular cycles), cyclic pelvic pain or lower abdominal discomfort that worsens around the expected menstrual period, and sometimes backache or bloating due to trapped menstrual blood (hematometra). In severe cases, patients may experience acute, crampy lower abdominal pain, fever (if infection develops), or even signs of endometriosis due to retrograde menstruation. Importantly, fertility may be compromised, as cervical stenosis can impede sperm passage and hinder embryo implantation. Diagnosis typically involves pelvic examination, transvaginal ultrasound (to assess for hematometra or fluid collection), and hysteroscopy—the gold standard for direct visualization and confirmation of adhesions. Management depends on severity and may include cervical dilation, hysteroscopic adhesiolysis, and post-procedural hormonal therapy (e.g., estrogen) with mechanical barrier placement (e.g., intrauterine balloon or device) to prevent re-adhesion.