Cryptomenorrhea

Cryptomenorrhea or cryptomenorrhoea, also known as hematocolpos, is a condition where menstruation occurs but is not visible^[1] due to an obstruction of the outflow tract. Specifically the endometrium is shed, but a congenital obstruction such as a vaginal septum or on part of the hymen retains the menstrual flow. A patient with cryptomenorrhea will appear to have amenorrhea but will experience cyclic menstrual pain. The condition is surgically correctable.

The patient usually presents at the age of puberty when the commencement of menstruation blood gets collected in the vagina and gives rise to symptoms.

Symptoms

Eugonadotropic primary amenorrhea and cyclical lower abdominal pain are the chief presenting complaints of hematocolpos. Patient may be brought in emergency urinary retention.

Signs

• Abdominal examination: swelling is felt on palpation.
• On vulval inspection: a tense, bulging, bluish membrane is seen, this finding varies according to the thickness of the obstructing membrane. It may be absent in patients with complete or partial vaginal agenesis.
• On rectal examination: a large bulging mass is felt.

Investigations

can be easily diagnosed on ultrasound, vagina is seen filled with blood and uterus is pushed upward. associated hematosalpinx and hematometra may be seen.

Complications

• hematometra (collection of blood in the uterine cavity)
• hematosalpinx (collection of blood in fallopian tubes)
• endometriosis in long-standing cases
• in severe, untreated forms, infertility and urinary retention

Treatment

A thin perforate membrane needs a simple excision and the retained blood drains out over the next few days. A thicker transverse vaginal septum can be treated with Z-plasty. A blind vagina will require a partial or complete vaginoplasty. Hematosalpinx may require laprotomy or laparoscopy for removal and reconstruction of affected tube.

Infertility may require assisted reproductive techniques.

References