Hematometra associated with estrogen replacement therapy

We have described two cases of hematometra occurring after initiation of estrogen replacement therapy. In both cases, cervical stenosis had developed during a prolonged period of hypoestrogenism. After initiation of sequential estrogen/progestin therapy, the stenosis prevented menstrual flow, and sonography revealed an asymptomatic hematometra in both cases. Based on these cases, we recommend doing a baseline evaluation of cervical patency before initiating estrogen replacement therapy in women who have been menopausal for a substantial length of time.