Hematometra, otherwise known as hemometra is a condition in which blood is collected and retained in the uterus, commonly the result of an imperforate hymen or transverse vaginal septum.
The physical obstruction of menstrual blood from the uterus causes a significant back up of menstrual blood over time, which can cause the uterus to enlarge, putting pressure on other pelvic organs, similar to in the case of hematocolpos. For this reason, the condition tends to worsen to longer the patient prolongs seeking medical attention.
Many women do not immediately seek medical attention for abdominal pain, and so the condition can be allowed to progress over a significant timeframe as sufferers become accustomed to the pain. Medical detection usually comes late as the condition usually presents during puberty when the women may be unsure of how to interpret the symptoms, or other embarrassed to seek help.
Clinical Presentation
Hematometra will typically present with periodic cramping and pain in the lower abdomen, localised on the midline1. Patients may also complain of urinary frequency or retention as the condition begins to affect the rest of the pelvic cavity.
Dysmenorrhea and amenorrhea are also commonly reported by patients.
Medical Management
Surgical intervention is often necessary in order to remove any tissues that may be obstructing the flow of menstrual blood through the uterus, such a hysteroscopy. Cervical dilation is also a common surgical intervention utilised to drain the uterus2.
Pathophysiology
Hematometra develops when the uterus becomes distended with blood secondary to an obstruction of the lower reproductive tract -the uterus, cervix or vagina – which should otherwise allow the flow of menstrual blood3.
Hematometra most commonly develops secondary to a congenital abnormality such as an imperforate hymen, transverse vaginal septum or vaginal hypoplasia. Any other causes are generally acquired, such as cervical stenosis, intrauterine adhesions, endometrial cancer, and cervical cancer2.
[…] The condition commonly goes unnoticed until adolescence when the girl passes the age of menarche5 and has not had a period (amenorrhea). Menstrual blood cannot flow freely from the vagina and backs up in the vagina (Hematocolpos) or the uterus (Hematometra). […]