What is hematometra?

Hematometra refers to the accumulation of varying amounts of blood in the uterine cavity, which can be caused by different factors and presents with varying clinical symptoms. Some cases with significant blood accumulation may manifest as vaginal bleeding, abdominal pain, or lower abdominal distension, while others may be asymptomatic and only detectable via ultrasound.

Which department should I visit for hematometra?

English name: Hematometra.

Alternative names: Uterine blood accumulation, intrauterine hematoma.

Department: Obstetrics and Gynecology.

What causes hematometra?

There are multiple causes of hematometra, including:

• Pregnancy-related bleeding: Blood accumulation due to bleeding near the gestational sac or placental abruption, or postpartum uterine atony leading to significant intrauterine blood retention.
• Endometrial lesion bleeding: Benign conditions like endometritis, polyps, or fibroids, or malignant conditions like endometrial or cervical cancer, which may result in hematometra as the disease progresses.
• Reproductive tract malformations or intrauterine/cervical adhesions: Adhesions after procedures like abortion, or congenital conditions like imperforate hymen obstructing menstrual blood flow.
• Menstrual abnormalities: Incomplete expulsion of menstrual blood from the uterine cavity.

Who is most at risk for hematometra?

Hematometra primarily affects post-pubescent women, with varying predispositions based on the cause. Adolescents often experience it due to reproductive tract malformations, while women of reproductive age are more likely to develop it from pregnancy, uterine procedures, menstrual irregularities, or benign endometrial conditions.

Endometrial atrophy and polyps are the most common causes of postmenopausal intrauterine bleeding. In 5%–10% of cases, bleeding is caused by endometrial cancer.
No authoritative statistics currently detail age-specific incidence rates.

What are the main symptoms of hematometra?

Symptoms vary depending on the underlying cause:

• Reproductive tract malformations or adhesions may cause absent menstruation with cyclical abdominal pain and lower abdominal distension.
• Infections may lead to fever, foul-smelling or bloody vaginal discharge, and fatigue.
• Premenopausal women may experience irregular bleeding, heavy or prolonged periods.
• Postmenopausal women may present with irregular vaginal bleeding. Advanced malignancy-related cases can include anemia, weight loss, and cachexia.
• Pregnancy-related hematometra may show no symptoms with minor bleeding (detected only via ultrasound) or progress to abdominal distension, backache, pain, or vaginal bleeding.

How is hematometra diagnosed?

Diagnostic methods include:

• Gynecological exam: Assessing cervical abnormalities, uterine enlargement/tenderness, or parametrial conditions.
• Lab tests: Vaginal discharge analysis, complete blood count, and tumor markers.
• Imaging: Pelvic ultrasound; CT/MRI for suspected malignancies.
• Pathology: Cervical biopsy (for cervical cancer), diagnostic curettage, or hysteroscopy to evaluate endometrial diseases.

How is hematometra treated?

Treatment depends on the cause:

• Surgery for obstructive causes like malformations or adhesions.
• Antibiotics for severe endometritis; observation or surgery for polyps/fibroids.
• Pregnancy-related cases may require monitoring, tocolytics, or hemostatic therapy.
• Hormonal regulation for menstrual irregularities.
• Malignancies require staged treatment plans.

What is the prognosis for hematometra?

• Most non-malignant or non-pregnancy-related cases resolve well with treatment, without impacting daily life.
• Pregnancy-related outcomes depend on bleeding severity and maternal/fetal health.
• Cancer prognosis varies by stage, pathology, and metastasis; early treatment improves survival rates.

How to prevent hematometra?

Maintain personal hygiene to prevent infections. Schedule annual gynecological exams and seek prompt care for abnormalities. Adolescents without menstruation but experiencing cyclical pain should seek immediate evaluation.