[What lesions of the myometrium are responsible for hemorrhage?]

Based on a personal series of 54 cases of endo-uterine haemorrhage with normal endometrium, the authors show that lesions of the myometrium which may result in haemorrhages, consist mainly of interstitial or submucous myomas and adenomyosis, i.e. lesions on which medical treatments are ineffective. Ultrasonography, but mainly clinical data and hysterography very often demonstrate the lesions and are sufficient to indicate a hysterectomy or a myomectomy. The problem is more difficult when the clinical, ultrasonographic and hysterographic work-up is negative or barely evocative. In these cases, after ruling out certain functional haemorrhages or a haemorrhagic disease, it is useful to take an histological sample of the endometrium either by curettage or biopsy, on an ambulatory basis (using Inocurette for instance). If this examination is normal, hysterectomy is indicated, because, in their experience, there are such lesions of the myometrium, that recurrence of the haemorrhages is inevitable.