This is an accumulation of blood within the uterus.

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 (e.g. 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

Presentation

• 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. CA-125 and CA19-9 may be elevated.⁶

Investigations

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

Management

This will depend on the cause, e.g. imperforate hymen can be incised.

Complications

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

Document references

1. Dadhwal V, Mittal S, Kumar S, et al; Hematometra in postmenarchal adolescent girls: a report of two cases.; Gynecol Obstet Invest. 2000;50(1):67-9. [abstract]
2. Gomez Arzapalo E, Perez Mendizabal A, Herrera Avalos I, et al; ; Ginecol Obstet Mex. 2001 May;69:206-8. [abstract]
3. McCausland AM, McCausland VM; Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention. J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):399-406. [abstract]
4. Grimes DA, Creinin MD; Induced abortion: an overview for internists.; Ann Intern Med. 2004 Apr 20;140(8):620-6. [abstract]
5. Nayci A, Avlan D, Oz U, et al; Does menstrual flow exclude hematometra? A rare case of uterine anomaly presenting with anorectal malformation.; J Pediatr Surg. 2002 Apr;37(4):666-7. [abstract]
6. Buyukbayrak EE, Ozyapi AG, Karsidag YK, et al; Imperforate hymen: a new benign reason for highly elevated serum CA 19.9 and CA Arch Gynecol Obstet. 2008 May;277(5):475-7. Epub 2007 Nov 7. [abstract]
7. Chircop R; A case of retention of urine and haematocolpometra.; Eur J Emerg Med. 2003 Sep;10(3):244-5. [abstract]

Acknowledgements