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A twenty-four year old gravid zero with a history of endometriosis presented with recurrent hematometra and pelvic pain. The patient had been treated previously with laparoscopy for her endometriosis followed by nine months of a gnRH agonist. She developed amenorrhea and cyclic pelvic pain. Ultrasound revealed a large hematometra. On pelvic exam, the patient had cervical hypoplasia; the patient's cervix was flushed with the vagina without a defined cervico-vaginal junction. The endocervical canal was entered sharply and dilated using ultrasound guidance. Hysteroscopy performed revealed an intracavitary septum and intrauterine adhesions which were resected and a foley catheter was placed. After removal of the foley catheter the patient's hematometra redeveloped and the cervix remained stenotic. Another trial of an intrauterine foley catheter and estrogen treatment was performed but hematometra redeveloped. The patient desired to retain her fertility. Finally a levonogestrel-releasing intrauterine system was placed using ultrasound and laparoscopic guidance. The patient has not experienced recurrence of hematometra and her pelvic pain is significantly improved. Little information is available about patients with endometriosis and cervical abnormalities. This case of cervical stenosis and hypoplasia resulting in recurrent hematometra was successfully treated with an intrauterine device.
Hysteroscopy and Ultrasound guided levonogesterol-releasing intrauterine device.
Measurements and Main Results
Episodes of cyclic hematometria resolved by the intervention.
In the presence of cervical stenosis leading to recurrent hematometria, a levonogestrel-releasing intrauterine device may provide relief.