Voluminous hematometra and cervical stenosis treated with office hysteroscopy

A postmenopausal patient referred due to stress urinary incontinence presented with severe atrophy of the upper third of the vagina and an enlarged uterus. A voluminous hematometra and cervical dilation were detected and further characterized by MRI. The patient underwent an office hysteroscopy using a vaginoscopic approach without anestesia. The stenosis was resolved using 5Fr scissors, and one liter of old blood was evacuated. This minimally invasive procedure represents the gold standard in these settings, allowing for direct visualization and overcoming stenosis while minimizing the risk of injury.