What causes corpus luteum hematoma?

Corpus luteum hematoma is a relatively serious symptom that can cause women to experience vaginal bleeding and abdominal pain, which is somewhat similar to the symptoms of ectopic pregnancy. Corpus luteum hematoma is mainly caused by excessive corpus luteum bleeding during the follicular phase. It is usually unilateral, and after the corpus luteum hematoma is absorbed, it will form a corpus luteum cyst, which will affect the female's uterine function and pregnancy, and requires timely treatment.

1. Symptoms of Corpus Luteum Hematoma

symptom

The normal corpus luteum has a diameter of about 15 mm. It then transforms into a corpus albicans and naturally disappears during the follicular phase of the next cycle. If the amount of bleeding in the corpus luteum is large, it will form corpus luteum hematoma, also known as intraluteal bleeding or hemorrhagic corpus luteum. Corpus luteum hematoma is mostly unilateral, with a general diameter of 40mm, occasionally up to 100mm. After the corpus luteum hematoma is absorbed, it may lead to corpus luteum cyst. When a larger hematoma ruptures, intra-abdominal bleeding may occur, with severe abdominal pain, a small amount of vaginal bleeding and peritoneal irritation signs, which are difficult to distinguish from ectopic pregnancy.

1. In the early stage of corpus luteum hematoma, when there is a lot of bleeding in the cyst, it manifests as a nearly round cyst in the ovary, with thick cyst wall, rough inner wall, messy, heterogeneous and low echo inside the cyst, and diverse echo manifestations. (Sometimes nearly inhomogeneous solid echo)

2. In the middle stage of corpus luteal hematoma, the blood in the corpus luteal hematoma coagulates and is partially absorbed. The cyst wall becomes thinner and the inner wall becomes smooth. The echo inside the cyst decreases, presenting a coarse reticular and fine reticular structure. (Dense dot-like echoes can also be seen in the cyst)

3. In the late stage of corpus luteum hematoma, the cyst becomes smaller after blood is absorbed and turns into a white body. The internal echo is solid and slightly high-echo, and the boundary with the surrounding ovarian tissue is unclear. It is judged by the surrounding annular blood flow shown by color ultrasound. When the blood is completely absorbed, a corpus luteum cyst is formed, the cyst wall becomes smooth, and there is no echo inside the cyst, which is difficult to distinguish from other ovarian cysts.

4.CDFI: The color Doppler ultrasound manifestations of corpus luteum hematoma or corpus luteum cyst are characteristic. A supplying blood vessel can be seen in the medulla of the corpus luteum sac near the ovary, with radial branches extending to the corpus luteum sac wall. Color Doppler or power Doppler blood images can show a circle or half circle of blood flow signals around the corpus luteum sac.

2. What is corpus luteum hematoma?

After normal ovulation, the remaining follicle wall collapses to form the corpus luteum. Under the action of luteinizing hormone, the volume of the corpus luteum reaches its peak after 7-8 days. The diameter of a normal corpus luteum is about 15 mm. During the luteal phase, the ovaries of normal women of childbearing age have abundant blood flow and maintain a balance with the corpus luteum function. During the ovarian corpus luteum angiogenesis stage, a large number of capillaries from the theca pass through the granulosa lutein cell layer and extend inward, forming sinusoidal blood vessels opening into the corpus luteum cavity. Under normal circumstances, there is a small amount of bleeding.

If there is a lot of bleeding in the corpus luteum during the luteal vascular formation period, or the corpus luteum does not degenerate and continues to secrete progesterone, blood will be retained in the corpus luteum cavity and form a corpus luteum hematoma.

During the formation of the corpus luteum, the corpus luteum hematoma liquefies and may form a corpus luteum cyst. The diameter of a corpus luteum cyst is generally greater than 30 mm, and sometimes the size of a corpus luteum cyst or a hemorrhagic corpus luteum cyst can reach 80 mm or even larger.

Due to the influence of the amount of bleeding or the duration of bleeding, the ovarian corpus luteum hematoma on ultrasound images may appear diverse and needs to be differentiated from ovarian teratoma, fibroma, chocolate cyst, and even ectopic pregnancy.

The most important point is that corpus luteum hematoma can spontaneously rupture and bleed or be absorbed. Most corpus luteum hematomas may show significant reduction or spontaneous disappearance on ultrasound examination 3-5 days after the next menstrual period. When bleeding is heavy, the pressure in the corpus luteum cavity increases, causing spontaneous rupture and bleeding. The corpus luteum of pregnancy can also enlarge and form a cyst, which usually disappears naturally around the third month of pregnancy.