Haematometra

What is a haematometra?

This is an accumulation of blood within the uterus.

Haematometra causes (aetiology)

• It may be caused by Müllerian duct anomalies.¹

• Imperforate hymen.

• In older women, it may be secondary to carcinoma of cervix or cervical stenosis (eg following cone biopsy).

• Other causes include infection with Listeria monocytogenes, laser endometrial ablation, uterine curettage and cervical cryocoagulation or electrocoagulation.^{2 3}

• It may be the result of childbirth, either by normal vaginal delivery or assisted deliveries, such as forceps.

• Acute haematometra is a rare complication following induced termination of pregnancy.⁴

Symptoms of haematometra

• Amenorrhoea, but there may be some menstrual blood flow.⁵

• Lower abdominal swelling and tenderness.

• It may present with severe primary dysmenorrhoea.

• It may be associated with pyometra, especially after termination of pregnancy, when the patient may have a high fever and other evidence of infection.

• If due to an imperforate hymen, and therefore associated haematocolpos develops, the hymen may bulge and exhibit a bluish discoloration. In one case report, this led to elevations of CA-125 and CA19-9.⁶

Investigations

• Abdominal ultrasound.

• MRI scan may be required if the ultrasound result is unclear.

Treatment

This will depend on the cause - eg imperforate hymen can be incised.

Complications

It is a rare cause of urinary tract obstruction and urinary retention.⁷