Hematometra – Causes, Symptoms, Treatment

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 5 min read

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Hematometra is a pathologic collection of blood in the uterus. It is a rare condition that is most commonly associated with congenital anomalies or prior surgical procedures causing obstruction of the genitourinary outflow tract. Hematometra is a medical condition that involves the collection of blood...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

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Key Takeaways

This article explains Types of Hematometra in simple medical language.
This article explains Causes of Hematometra in simple medical language.
This article explains Symptoms of Hematometra in simple medical language.
This article explains Diagnosis of Hematometra in simple medical language.

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Hematometra is a pathologic collection of blood in the uterus. It is a rare condition that is most commonly associated with congenital anomalies or prior surgical procedures causing obstruction of the genitourinary outflow tract.

Hematometra is a medical condition that involves the collection of blood in the uterus. The most common cases occur due to uterine, cervical, and vaginal malformations; whereas, medical cases that cause obstruction of the cervical canal are far rarer. Imperforate hymen is a rare malformation of the vagina and a possible reason of hematocolpos and hematometra in puberty. This genital tract malformation has an incidence of 0.05% to 0.1%. This sporadic condition usually presents itself with the presence of a mass, lower abdominal pain, delayed menarche, and bulging vaginal membrane.

Acquired obstruction of the lower female genital tract is rare.[rx] Hematometra is retention of blood in the uterine cavity caused by obstruction to menstrual flow at the level of the uterus, cervix, or vagina. In older women, the obstruction is usually acquired and occurs at the level of the cervix.[rx] In young women, hematometra may be due to congenital anomalies such as an imperforate hymen or a noncommunicating Müllerian duct.[rx] Transabdominal sonography is a noninvasive imaging modality useful for examining occlusions of the genital tract.[rx] Transvaginal sonography is important in the evaluation of hematometra because it affords clear visualization of the endometrial cavity.[rx]

Types of Hematometra

The genital tract becomes dilated above the obstruction. If the dilation contains blood the terms used are:

Haematocolpos: vaginal distension – obstruction at the vaginal level
Haematometrocolpos: vaginal and uterine distension – obstruction at the vaginal level
Haematometra: uterine distension – obstruction at the cervical level
Haematosalpinx: dilation of fallopian tubes – obstruction at cornua.

Causes of Hematometra

Hematometra develops when the uterus becomes distended with blood secondary to obstruction or atresia of the lower reproductive tract—the uterus, cervix or vagina—which would otherwise provide an outflow for menstrual blood.^[rx] It is most commonly caused by congenital abnormalities, including imperforate hymen, transverse vaginal septum or vaginal hypoplasia. Other causes are acquired, such as cervical stenosis, intrauterine adhesions, endometrial cancer, and cervical cancer.^[rx]

Additionally, hematometra may develop as a complication of uterine or cervical surgery such as endometrial ablation, where scar tissue in the endometrium can “wall off” sections of endometrial glands and stroma causing blood to accumulate in the uterine cavity. It can also develop after abortion, as well as after childbirth. It can also develop after female genital mutilation.

The genital tract dilates above any congenital obstruction.
An intact hymen is the commonest cause.
An MR scan is almost 100% accurate in diagnosing congenital gynaecological anomalies.
There is an association with renal anomalies.
Primary amenorrhoea commonest presentation of an obstructed track.
Ultrasound will show the dilated tract as a central fluid-filled mass.
Failure to identify the uterus should always raise the possibility that an abnormal mass is in the uterus.
It may be caused by Müllerian duct anomalies.
Imperforate hymen.
In older women, it may be secondary to carcinoma of the cervix or cervical stenosis (eg following cone biopsy).
Other causes include infection with Listeria monocytogenes, laser endometrial ablation, uterine curettage and cervical cryocoagulation or electrocoagulation.
It may be the result of childbirth, either by normal vaginal delivery or assisted deliveries, such as forceps.
Acute haematometra is a rare complication following induced termination of pregnancy.

Symptoms of Hematometra

Hematometra typically presents as cyclic,

cramping pain in the midline of the pelvis or lower abdomen.^[rx] Patients may also report urinary frequency and urinary retention.^[rx]
Premenopausal women with hematometra often experience abnormal vaginal bleeding, including dysmenorrhea (pain during menstruation) or amenorrhea (lack of menstruation), while postmenopausal women are more likely to be asymptomatic.^[rx]
Due to the accumulation of blood in the uterus, patients may develop low blood pressure or a vasovagal response.^[rx] When palpated, the uterus will typically feel firm and enlarged.^[rx]
Amenorrhoea, but there may be some menstrual blood flow.^[rx]
Lower abdominal swelling and pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।" data-rx-term="tenderness" data-rx-definition="Tenderness means pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।">tenderness.
It may present with severe primary dysmenorrhoea.
It may be associated with pyometra, especially after the termination of pregnancy, when the patient may have a high fever and other evidence of infection.
If due to an imperforate hymen, and therefore associated haematocolpos develops, the hymen may bulge and exhibit a bluish discoloration.

Diagnosis of Hematometra

Although hematometra can often be diagnosed based purely on the patient’s history of amenorrhea and cyclic abdominal pain, as well as a palpable pelvic mass on examination, the diagnosis can be confirmed by ultrasound, which will show blood pooled in the uterus and an enlargement of the uterine cavity.^[rx]^[rx] A pyelogram or laparoscopy may assist in diagnosing any congenital disorder that is suspected to be the underlying cause of the hematometra.^[rx]

Treatment of Hematometra

Hematometra is usually treated by surgical cervical dilation to drain the blood from the uterus.^[rx] Other treatments target the underlying cause of the hematometra; for example, a hysteroscopy may be required to resect adhesions that have developed following previous surgery.^[rx] If the cause of the hematometra is unclear, a biopsy of endometrial tissue can be taken to test for the presence of a neoplasm (cancer).^[rx] Antibiotics may be given as prophylaxis against the possibility of infection.^[rx]

References

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

Write when the problem started and how it changed.
Bring old prescriptions, investigation reports, and current medicines.
Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

What is the most likely cause of my symptoms?
Which danger signs mean I should go to hospital quickly?
Which tests are necessary now, and which can wait?
How should I take medicines safely and what side effects should I watch for?
When should I come for follow-up?

Tests to discuss

Vital signs: temperature, pulse, blood pressure, oxygen saturation
Basic physical examination by a clinician
CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Avoid heavy lifting, sudden bending, and prolonged bed rest.
Use comfortable posture and gentle movement as tolerated.
Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician

Tests to discuss with doctor

Temperature chart and hydration assessment
CBC with platelet count if fever persists or dengue/other infection is possible
Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first
If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story
Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician
A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests
Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse
If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.