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Haematometra, a rare and delayed complication, can emerge following medical termination of pregnancy, also known as ‘postabortal post-caesarean syndrome’ or ‘redo syndrome’. Treatment requires the immediate evacuation of both liquid and clotted blood for quick resolution, followed by administration of an oxytocic agent to ensure complete recovery. This current report describes a female patient in her mid-30s who presented with colicky lower abdominal pain following a medically-induced abortion at 10 weeks. The case underscores the critical need for vigilance in detecting haematometra after abortion or caesarean delivery. Prompt recognition through symptoms and ultrasound, followed by immediate treatment, is essential to prevent severe complications such as infertility and ensure ongoing reproductive health.

An adolescent girl with acute myeloid leukaemia underwent chemotherapy followed by haematopoietic stem cell transplantation (HSCT). Post-HSCT, she developed oral chronic graft-versus-host disease (cGvHD), which was successfully treated. Twenty months later, she was referred to the gynaecology department for evaluation of secondary amenorrhoea. Hormonal assessment led to a diagnosis of primary ovarian insufficiency due to chemotherapy. She was prescribed hormone replacement therapy (HRT), but the absence of withdrawal bleeding prompted vaginal examinations, which revealed vaginal adhesions. A sonogram confirmed haematocolpos and haematometra resulting from silent genital cGvHD. The patient was managed surgically, followed by treatment with topical oestrogen and vaginal moulds. HRT was restarted, and she resumed regular menstruation. Over a routine 20-month follow-up period, no recurrence of symptoms was observed. This case highlights gynaecologic complications of cGvHD and emphasises the importance of gynaecological monitoring in post-transplant care to proactively identify and address genital cGvHD, preventing its irreversible complications.

Osseous metaplasia of the endometrium is a rare condition involving the bone tissue in the endometrial cavity. Its presence along with haematometra is an infrequent condition and is not reported until now. We present a case of a woman in her mid-30s with primary infertility and secondary amenorrhoea. On evaluation, she was diagnosed with osseous metaplasia, intrauterine synechiae and haematometra. Hysteroscopic removal of bone fragments was done along with synechiolysis which led to the return of menses.

This case report presents a woman in her 20s with VACTERL association who presented with acute on chronic 10-year pelvic pain and haematometra. Initially, diagnostic imaging suspected a didelphic uterus with a dilated right horn on CT imaging. However, after physical examination and further imaging, further diagnosis of unicornuate uterus with non-communicating horn was noted. After years of expectant management, the patient began to experience severe malnutrition and metabolic derangements. After significant patient-centred discussions regarding pain relief, the patient was refractory to oral contraceptive pills and later started on GnRH antagonists. After the patient underwent an abdominal hysterectomy and right salpingectomy with resolution of pain symptoms. The case highlights the complexities of managing patients with multiple congenital anomalies, particularly VACTERL, and while not in the constellation of syndromes, gynaecological complications may arise due to common embryological origins. This case emphasises the importance of a multidisciplinary approach in challenging scenarios.

Genital chronic graft-versus-host disease (GVHD) in women posthaematopoietic cell transplantation may cause vaginal mucosal sclerosis. Human papillomavirus (HPV) reactivation, also common post-transplantation, limits local immunosuppressive, but not oestrogen treatment. A 36-year-old nulliparous woman developed coincidental genital chronic GVHD and HPV 22 months after transplant for aplastic anaemia. Topical immunosuppression for GVHD led to an eruption of warts successfully treated with laser surgery and cone biopsy. She maintained normal ovarian function and used extended cycle combined hormonal contraception. A vaginal oestrogen ring used continuously limited most scarring for 8 years. Progressive apical vaginal scarring obstructed menstrual flow leading to haematocolpos and haematometra. Normal anatomy was restored with a cruciate incision in the cervicovaginal scar performed during menses. When HPV disease limits use of topical immunosuppression in women with vaginal GVHD, the local scar-reducing effect of a vaginal oestrogen ring is limited, and surgery may be needed and can be successful in treating haematocolpos.This study was registered in ClinicalTrials.gov with trial registration number of NCT00003838.

[...]there is obstruction to menstrual flow in one cavity, resulting in haematometra, haematosalpinx and sometimes endometriosis. [...]significant limitations remain in diagnosing MDA subtypes on ultrasound. 2 MRI is the preferred method of imaging as it is capable of showing the endometrial cavity and uterine contour in exquisite detail, and it has shown excellent agreement with clinical MDA subtype diagnosis. 2 In cases of Robert's uterus the coronal T2W images of MRI are ideal for demonstrating the uterine septum dividing the endometrial cavity asymmetrically along with the blind ending cavity and haematometra.

Learning points Cervical stenosis can occur as a result of hypo-oestrogenism and vaginal atrophy. 1 Haematometra in a postmenopausal woman requires investigation for underlying malignancy.

Introduction Transverse vaginal septum occurs because there is a defect in vertical fusion during embryological development of the vagina. It is quite rare and is infrequently encountered by most obstetricians and gynecologists in their practice. Case report A 14-year-old unmarried student, Miss AUX, presented to a private gynecologist complaining of absent menses. Initial examination and investigation revealed intact hymen, normal uterus but no hematometra/hematocolpos. She was commenced on combined oral contraceptives [Yasmin] by the gynecologist. On December 14, 2007, she presented to Maternity hospital with a 6-months history of monthly cyclical abdominal pain with no menses. Physical examination and ultrasonography revealed a high transverse vaginal septum with hemotometra but no hematocolpos. Excision of the septum was performed under ultrasound guidance. The post operative period was uneventful. Normal menses were reported by the patient during outpatient follow-up. Conclusion The excision of a high transverse vaginal septum in a 14-year-old unmarried student, presented with cyclical abdominal pain and absent menses and confirmed to have hematometra, was followed by a return of regular menstruation.