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Hematometra after radiotherapy for cervical carcinoma
C B Vernooij1, R F Kruitwagen, P Rodrigus
1Bosch Medical Center, Department of Obstetrics and Gynecology, ME's-Hertogenbosch, The Netherlands.
Gynecologic Oncology
|January 27, 1998
Summary
Hematometra, a uterine complication, can occur after cervical cancer radiotherapy, especially with estrogen therapy. Adding progestagen to estrogen replacement therapy is crucial for patients with a history of cervical cancer.
Area of Science:
- Gynecologic Oncology
- Reproductive Endocrinology
Background:
- Radiotherapy for cervical carcinoma can lead to complications like hematometra, often associated with disease recurrence.
- Estrogen replacement therapy (ERT) is sometimes considered for postmenopausal women, but its use in patients with a history of cervical cancer requires careful consideration.
Observation:
- Two cases are presented where hematometra developed during ERT in patients previously treated for cervical cancer.
- The hematometra formation was linked to renewed endometrial activity, compounded by cervical or upper vaginal fibrosis and obliteration post-radiotherapy.
Findings:
- Endometrial tissue can regain proliferative capacity even after radiotherapy for cervical cancer.
- ERT in these patients, without a progestagen, can stimulate this regained endometrial activity, potentially leading to hematometra.
Implications:
- ERT for patients with a history of cervical cancer should incorporate a progestagen to counteract unopposed estrogenic stimulation.
- Routine uterine cavity examination is recommended in the absence of progesterone withdrawal bleeding to detect potential hematometra development.