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What is a haematometra?
This is an accumulation of blood within the uterus.
Haematometra causes (aetiology)
- It may be caused by Müllerian duct anomalies.
- 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.
Symptoms of haematometra
- Amenorrhoea, but there may be some menstrual blood flow.
- 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.
- Abdominal ultrasound.
- MRI scan may be required if the ultrasound result is unclear.
This will depend on the cause - eg imperforate hymen can be incised.
Further reading and references
Dadhwal V, Mittal S, Kumar S, et al; Hematometra in postmenarchal adolescent girls: a report of two cases. Gynecol Obstet Invest. 2000
Gomez Arzapalo E, Perez Mendizabal A, Herrera Avalos I, et al; [Hematometra & Listeria monocytogenes] Ginecol Obstet Mex. 2001 May
McCausland AM, McCausland VM; Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention. J Minim Invasive Gynecol. 2007 Jul-Aug14(4):399-406.
Grimes DA, Creinin MD; Induced abortion: an overview for internists. Ann Intern Med. 2004 Apr 20
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
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 May277(5):475-7. Epub 2007 Nov 7.
Chircop R; A case of retention of urine and haematocolpometra. Eur J Emerg Med. 2003 Sep