Thorne Julie G, Russell Elizabeth H, Rumbolt Danielle, Jamieson Mary Anne
Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada.
Breast and Body Imaging, Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada.
J Pediatr Adolesc Gynecol. 2018 Aug;31(4):416-419. doi: 10.1016/j.jpag.2018.01.005. Epub 2018 Feb 14.
Abdominal pain, secondary amenorrhea, and abnormal uterine bleeding are common gynecologic presentations in adolescence. Rarely this can be associated with an acquired hematometra. Hematometra is a condition of retained blood or clot within the uterus. High-dose progestogenic agents in this age group have been implicated in the accumulation of a hematometra without other explanation.
We present 4 cases of hematometra after depomedroxyprogesterone acetate (DMPA) therapy in previously menstruating adolescents. All 4 presented with abdominal pelvic pain and/or persistent abnormal uterine bleeding, with the diagnosis confirmed via ultrasound. Suction dilation and curettage was required in each case.
DMPA is a possible cause of hematometra and should be considered in anatomically normal young women experiencing pain or abnormal bleeding out of character for typical long-term DMPA use.
腹痛、继发性闭经和异常子宫出血是青少年常见的妇科症状。极少数情况下，这可能与后天性子宫积血有关。子宫积血是指子宫内血液或血块潴留的一种情况。在这个年龄组中，高剂量孕激素制剂被认为是导致子宫积血积聚的原因，且无其他解释。
我们报告了4例既往有月经的青少年在接受醋酸甲羟孕酮（DMPA）治疗后发生子宫积血的病例。所有4例均表现为下腹盆腔疼痛和/或持续性异常子宫出血，通过超声确诊。每例均需要进行吸宫刮宫术。
DMPA可能是子宫积血的一个原因，对于解剖结构正常但出现疼痛或异常出血（不符合典型长期使用DMPA特征）的年轻女性应考虑这一因素。
