Recurrent Hematocolpos and Hematometra as a Late Complication of Endometrial Ablation: A Case Report

Endometrial ablation functions as a minimally invasive procedure to treat heavy menstrual bleeding when other treatments prove ineffective. The procedure maintains safety for most patients, yet they may experience delayed complications, which include obstructive issues such as hematometra and hematocolpos. We present the case of a 48-year-old patient who developed recurring symptomatic hematocolpos and hematometra three months following her endometrial ablation procedure for treating excessive menstrual bleeding. The patient experienced periodic lower abdominal discomfort, which imaging tests, including pelvic transvaginal ultrasound, CT scan, and MRI, confirmed resulted in hematometra. The patient underwent two drainage procedures under general anesthesia. The patient underwent a hysterectomy after a third occurrence of identical symptoms through a shared decision-making process. The histopathological examination revealed intrauterine fibrosis and cervical canal blockage, but no evidence of cancer. This case illustrates an unusual yet crucial complication that occurs following endometrial ablation treatments. Medical staff must recognize cyclic pelvic pain and amenorrhea as warning indicators of obstructive pathology to provide timely treatment. The management of this condition requires a systematic treatment approach that starts with observation and pain management before advancing to hysteroscopic revision. The first step in managing obstructive pathology requires complete imaging through transvaginal ultrasound and MRI when needed to assess the degree of anatomical blockages. The initial approach for treating obstructive pathology involves monitoring the patient while providing pain management through conservative methods. The treatment plan shifts to hysteroscopic revision as a minimally invasive procedure after conservative approaches fail to deliver sustained results. The patient needs a hysterectomy as their last treatment option after both conservative and hysteroscopic methods fail to deliver symptom relief. The selection of surgical treatment depends on how severe the symptoms are and how long they persist, as well as the extent of fibrosis and anatomical blockage severity, and the patient's desire to keep their uterus. Medical practitioners need to evaluate post-ablation hematometra or hematocolpos in women who present with cyclic pelvic pain and amenorrhea. The prevention of morbidity requires immediate imaging tests along with prompt medical interventions.