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<p>Hematometra refers to the abnormal accumulation of blood within the uterine cavity, typically due to congenital structural anomalies. However, it may also arise from acquired conditions such as cervical stenosis, obstructive tumors, or intrauterine adhesions. Rarely, it may be idiopathic, with limited evidence linking it to long-term use of depot medroxyprogesterone acetate (DMPA). A 41-year-old non-pregnant female, parity 3, living 3, all by normal vaginal deliveries (NVD), presented to our hospital’s outpatient gynecology clinic with complaints of hypomenorrhea and recurrent, unexplained lower abdominal pain for the past three years. She had no significant medical or surgical history. The patient had been using DMPA for contraception for the last 17&#xa0;years. On examination, she had a tender lower abdomen, with a uterine fundus corresponding to 14&#xa0;weeks in size. She underwent dilatation and curettage (D&amp;C), with uterine and cervical samples sent for pathological evaluation, revealing no evidence of malignancy or other abnormalities. Post-procedure, she was discharged home on oral antibiotics for 5&#xa0;days and scheduled for follow-up. Two weeks later, she returned with lower abdominal pain, and ultrasound revealed recurrent hematometra. The same management plan was repeated, including D&amp;C and antibiotic coverage, and she was again discharged after ensuring clinical stability. At her 1-month follow-up, the patient continued to report mild vague abdominal discomfort and persistent hypomenorrhea. Ultrasound findings were consistent with a third recurrence of hematometra. This time, the team opted for outpatient uterine sounding following misoprostol (cytotec) administration, discontinued DMPA, and initiated contraceptive transition to Implanon® (etonogestrel implant). A follow-up visit was scheduled after three months. At her final follow-up (6&#xa0;months from the last recurrence), the patient was asymptomatic, and ultrasound revealed a normal-sized, empty uterus, with resolution of the hematometra. This case highlights idiopathic, recurrent hematometra potentially associated with long-term DMPA use in the absence of Müllerian anomalies, prior surgeries, or other identifiable causes.</p>

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Unexplained Recurrent Hematometra in a Premenopausal Woman: Potential Association with Prolonged Use of DMPA? A Case Report

  • 期刊论文

  • 发表日期：

    2025年5月26日

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  • Bassant Farag Elshatby,
  • Eslam Mohammed Rabea,
  • Ahmed Abd Elhady Abd Elsadek

摘要

Hematometra refers to the abnormal accumulation of blood within the uterine cavity, typically due to congenital structural anomalies. However, it may also arise from acquired conditions such as cervical stenosis, obstructive tumors, or intrauterine adhesions. Rarely, it may be idiopathic, with limited evidence linking it to long-term use of depot medroxyprogesterone acetate (DMPA). A 41-year-old non-pregnant female, parity 3, living 3, all by normal vaginal deliveries (NVD), presented to our hospital’s outpatient gynecology clinic with complaints of hypomenorrhea and recurrent, unexplained lower abdominal pain for the past three years. She had no significant medical or surgical history. The patient had been using DMPA for contraception for the last 17 years. On examination, she had a tender lower abdomen, with a uterine fundus corresponding to 14 weeks in size. She underwent dilatation and curettage (D&C), with uterine and cervical samples sent for pathological evaluation, revealing no evidence of malignancy or other abnormalities. Post-procedure, she was discharged home on oral antibiotics for 5 days and scheduled for follow-up. Two weeks later, she returned with lower abdominal pain, and ultrasound revealed recurrent hematometra. The same management plan was repeated, including D&C and antibiotic coverage, and she was again discharged after ensuring clinical stability. At her 1-month follow-up, the patient continued to report mild vague abdominal discomfort and persistent hypomenorrhea. Ultrasound findings were consistent with a third recurrence of hematometra. This time, the team opted for outpatient uterine sounding following misoprostol (cytotec) administration, discontinued DMPA, and initiated contraceptive transition to Implanon® (etonogestrel implant). A follow-up visit was scheduled after three months. At her final follow-up (6 months from the last recurrence), the patient was asymptomatic, and ultrasound revealed a normal-sized, empty uterus, with resolution of the hematometra. This case highlights idiopathic, recurrent hematometra potentially associated with long-term DMPA use in the absence of Müllerian anomalies, prior surgeries, or other identifiable causes.