Hematometra

Introduction

• Description: Hematometra is a collection of blood in the body (cavity) of the uterus, resulting from the obstruction of the normal outflow tract. This obstruction may result from congenital abnormalities, acquired cervical stenosis, iatrogenesis (dilation and curettage, endometrial ablation), or obstruction by neoplasia.

• Prevalence: Uncommon.

• Predominant Age: Early reproductive and postmenopausal age most common.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Obstruction or atresia of the uterine outflow tract (congenital malformation; most common are imperforate hymen and transverse vaginal septum, acquired causes; cervical stenosis from senile atrophy of the endocervix and endometrium, scarring by synechiae, scarring after surgery, endometrial ablation, radiation, cryocautery, electrocautery, neoplasia).

• Risk Factors: Previous cervical surgery (cone biopsy, cryocoagulation, or electrocautery), menopausal atrophy, cervical neoplasia, incomplete endometrial ablation.

Signs and Symptoms

• Asymptomatic (especially in postmenopausal women)

• Uterine enlargement (often soft and slightly tender)

• Dysmenorrhea, abnormal bleeding, amenorrhea and infertility in premenopausal women

• Cyclic abdominal pain

Diagnostic Approach