Cause or Coincidence? Spontaneous Hematometra in Young Women Receiving Depomedroxyprogesterone Acetate: A Small Case Series.

BACKGROUND: Abdominal pain, secondary amenorrhea, and abnormal uterine bleeding are common gynecologic presentations in adolescence. Rarely this can be associated with an acquired hematometra. Hematometra is a condition of retained blood or clot within the uterus. High-dose progestogenic agents in this age group have been implicated in the accumulation of a hematometra without other explanation. CASES: We present 4 cases of hematometra after depomedroxyprogesterone acetate (DMPA) therapy in previously menstruating adolescents. All 4 presented with abdominal pelvic pain and/or persistent abnormal uterine bleeding, with the diagnosis confirmed via ultrasound. Suction dilation and curettage was required in each case. SUMMARY AND CONCLUSION: DMPA is a possible cause of hematometra and should be considered in anatomically normal young women experiencing pain or abnormal bleeding out of character for typical long-term DMPA use.

Acute abdominal pain caused by hematometra in an adolescent female: a case report.

BACKGROUND: Hematometra is a pathologic collection of blood in the uterus. It is a rare condition that is most commonly associated with congenital anomalies or prior surgical procedures causing an obstruction of the genitourinary outflow tract. We present an unusual case of hematometra in a healthy and active adolescent female with no prior risk factors. This is a rare and important case report due to the complexity of diagnosis when a young female presents with an acute abdomen. In addition, for a patient who presents with no prior risk factors for hematometra, such as in our patient, the diagnosis and workup may become overly complicated, adding strain to patient care and health care cost. To the best of our knowledge and based on an extensive literature search, there has not been a reported case of hematometra in an adolescent female without any aforementioned risk factors. CASE PRESENTATION: Our patient is a healthy 18 year-old white woman with no significant prior medical or surgical history. Her only medication was depot medroxyprogesterone acetate use for contraception. She presented to a local emergency department with acute abdominal pain, accompanied by emesis and nausea. Workup with ultrasonography showed uterine distention most likely caused by hematometra, although no obvious cause was noted. She was treated with dilation and curettage; she was also advised to discontinue depot medroxyprogesterone acetate use. She was symptom free without recurrence of hematometra at 6-month follow-up. CONCLUSIONS: Due to the high prevalence of abdominal pain, this case report has a wide breadth of implications for health care providers ranging from general family practitioners to emergency room physicians and obstetricians/gynecologists. This case report provides potential future advancement in management and differential diagnosis in adolescent females presenting with acute abdominal pain. In addition, the use of depot medroxyprogesterone acetate contributing to or causing hematometra cannot be ruled out in our patient and warrants further investigation.

Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention.

At first, total endometrial ablation seemed extremely safe in the short term. However, as time passed, certain unique long-term complications became evident. The problem is that after this procedure, intrauterine scarring and contracture can occur. Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed and cause problems such as central hematometra, cornual hematometra, postablation tubal sterilization syndrome, retrograde menstruation, and potential delay in the diagnosis of endometrial cancer. The incidence of these complications is probably understated because most radiologists and pathologists have not been educated about the findings to make the appropriate diagnosis of cornual hematometra and postablation tubal sterilization syndrome. This review will thoroughly discuss how to diagnose and treat these problems. Possible ways of preventing these long-term complications will also be discussed.

Tratamiento de un hematómetra con sonda de Foley en un caso de agenesia vaginal / Hematometra treated with Foley catheter in vaginal agenesis

El síndrome de Rokitansky se caracteriza por amenorrea primaria en pacientes fenotípicamente femeninas, con ausencias de vagina y con otras malformaciones asociadas --del propio aparato genital, urinarias, esqueléticas o cardíacas--, y con ovarios funcionantes. La agenesia vaginal puede ser causa de retención de sangre y secreciones, con la consiguiente formación de un hematómetra, que produciría una gran masa pélvica y dolor intenso; y puede ser necesario realizar su drenaje y utilizar un catéter de Foley, para evitar posibles reestenosis con recidiva del hematómetra. Describimos el caso de una adolescente con agenesia de los 2/3 superiores de la vagina, sin otras malformaciones asociadas, a la cual fue necesario realizarle drenaje de un hematómetra por los intensos dolores que le causaba (AU)

Frequency of symptomatic cornual hematometra and postablation tubal sterilization syndrome after total rollerball endometrial ablation: a 10-year follow-up.

OBJECTIVE: This study was undertaken to determine the frequency of symptomatic cornual hematometra and postablation tubal sterilization syndrome after total rollerball endometrial ablation and to describe methods for diagnosis, treatment, and prevention. STUDY DESIGN: Retrospective cases of 50 consecutive patients who received total rollerball endometrial ablation for dysfunctional uterine bleeding were followed up for 10 years. RESULTS: Symptomatic cornual hematometra or postablation tubal sterilization syndrome was diagnosed by ultrasound scanning and/or magnetic resonance imaging in 5 of 50 patients (10%) who had a total endometrial ablation. Two patients had cornual hematometra, and 3 patients had postablation tubal sterilization syndrome 4 months to 90 months after rollerball ablation. Subsequent gonadotropin-releasing hormone agonist treatment or hysteroscopic decompression of the hematometra was only partially successful, and recurrence of symptoms necessitated hysterectomy with salpingectomy. CONCLUSION: Uterine contracture, which obstructs bleeding from persistent cornual endometrium and leads to symptomatic cornual hematometra or postablation tubal sterilization syndrome, is not uncommon after total rollerball endometrial ablation, with an incidence of 10% in our series. Satisfactory treatment requires hysterectomy with salpingectomy, but modifications such as partial endometrial ablation can prevent these complications.

Criptomenorreia / Cryptomenorrhea

Os autores fazem revisao das principais causas de criptomenorreia, e tecem comentarios acerca dos aspectos clinicos, propedeuticos e terapeuticos atuais dessa entidade patologica relativamente rara na pratica ginecologica

Hysteroscopic treatment of congenital uterine malformations causing hemihematometra: a report of three cases.

To our knowledge, this is the first case report of hysteroscopic treatment of congenital uterine malformations with one-sided occlusion causing hemihematometra. This rare form of uterine anomaly should be considered when symptoms such as increasing pelvic pain start with menarche. A 9-mm resectoscope was used for dissecting the way into the occluded part of the uterine body. There the endometrium was ablated for prevention of recurrence of hemihematometra. By this endoscopic approach the disadvantages of laparotomy could be avoided in three adolescent patients.