Hematometra

Specialty: Gynecology and breast.

• Accumulation of blood in the uterus
• uterine blood retention
• obstruction of menstrual flow

Why it occurs

• Acquired cervical canal stenosis (complication secondary to previous cervical conization, cryotherapy, local radiotherapy or aggressive endometrial curettage)
• Imperforate hymen or transverse vaginal septum (in adolescents who have not had menarche)
• Congenital obstructive uterine malformations (non-communicating rudimentary uterus)
• Carcinoma of the cervix or endometrium that mechanically obstructs the internal cervical os

Initial workup

Detailed external genital examination (in adolescents to visualize a bulging, bluish imperforate hymen). Transvaginal or transabdominal gynecological ultrasound (a markedly distended uterine cavity occupied by a homogeneous echogenic liquid content compatible with accumulated blood is observed). Pelvic MRI if there is suspicion of complex Müllerian malformation.

Standard management

• There are no drugs that resolve mechanical obstruction of the cervical or hymenal canal. The treatment of choice consists of instrumental dilation of the cervix under anesthesia in the office or operating room to allow immediate drainage of retained blood, or performing a cross cut (hymenotomy) in case of imperforate hymen. NSAIDs such as Ibuprofen 600 mg orally every 8 hours or intravenous analgesia can be used to control acute spasmodic pain during the obstructive phase or after the dilation procedure (note: after cervical dilation, it is advisable to maintain follow-up to monitor scar restenosis).