Recurrent hematometra in a young woman taking depot medroxyprogesterone-a case report

Abstract

Hematometra is defined as the pathologic collection of blood within uterine cavity typically resulting from lower genital tract obstruction. Depot medroxyprogesterone acetate (DMPA) is an injectable progestin contraceptive possibly linked to spontaneous hematometra. This case report describes a young female receiving DMPA who presented with recurrent hematometra. A 31year old, non-pregnant woman, presented with continuous lower abdominal pain and severe dysmenorrhoea with history of receiving two doses of DMPA three months apart. She had undergone cervical dilatation with hematometra drainage twice before she presented to us. MRI abdomen and pelvis revealed adenomyotic bulky uterus with hematometra. Diagnostic hystero-laparoscopy was performed. Cervical stenosis noted. Mechanical cervical dilatation with hematometra evacuation done. She was advised to discontinue DMPA and take Dienogest post-operatively for 3 months. This case illustrates a rare presentation of recurrent hematometra which may possibly be linked to DMPA use. Long term DMPA use results in hypoestrogenic state, which can cause significant atrophy of endometrial and endocervical lining and this atrophy might lead to stenosis of cervical os leading to hematometra. Mechanical dilatation of cervix and evacuation of hematometra is considered as gold standard, but may be insufficient. In the patients receiving DMPA, a high index of suspicion for hematometra should be maintained. This case report contributes to emerging evidence of potential association between DMPA usage and occurrence of hematometra. It is observed that these cases can be effectively managed by Contraceptive modification.