Not Found
Locations

Find information on medical topics, symptoms, drugs, procedures, news and more, written for the health care professional.

* This is the Professional Version. *

Cervical Stenosis

By S. Gene McNeeley, MD, Hutzel Women’s Hospital;Michigan State University, College of Osteopathic Medicine, Hutzel Women’s Health Specialists

Click here for
Patient Education

Cervical stenosis is stricture of the internal cervical os.

Cervical stenosis may be congenital or acquired.

The most common acquired causes of cervical stenosis are

  • Menopause

  • Cervical surgery (eg, conization, cautery)

  • Endometrial ablation procedures to treat uterine abnormalities that cause menorrhagia

  • Cervical or uterine cancer

  • Radiation therapy

Cervical stenosis may be complete or partial.

It may result in the following:

  • Hematometra (accumulation of blood in the uterus)

  • In premenopausal women, retrograde flow of menstrual blood into the pelvis, possibly causing endometriosis

  • Pyometra (accumulation of pus in the uterus), particularly in women with cervical or uterine cancer

Symptoms and Signs

Common symptoms in premenopausal women include amenorrhea, dysmenorrhea, abnormal bleeding, and infertility. Postmenopausal women may be asymptomatic for long periods.

Hematometra or pyometra may cause uterine distention or sometimes a palpable mass.

Diagnosis

  • Clinical evaluation

Cervical stenosis may be suspected based on symptoms and signs (particularly development of amenorrhea or dysmenorrhea after cervical surgery) or on inability to obtain endocervical cells or an endometrial sample for diagnostic tests (eg, for a Papanicolaou [Pap] test).

Diagnosis of complete stenosis is established if a 1- to 2-mm diameter probe cannot be passed into the uterine cavity.

If cervical stenosis causes symptoms or uterine abnormalities (eg, hematometra, pyometra), cervical cytology and endometrial biopsy or D & C should be done to exclude cancer. For postmenopausal women with no history of abnormal Pap tests and for women without symptoms or uterine abnormalities, no further evaluation is needed.

Treatment

  • Dilation and stenting if symptomatic

Treatment of cervical stenosis is indicated only if symptoms or uterine abnormalities are present and typically involves cervical dilation and placement of cervical stent.

Key Points

  • Cervical stenosis may be congenital or acquired (eg, caused by menopause, cervical surgery, endometrial ablation, cervical or uterine cancer, or radiation therapy).

  • Cervical stenosis can cause amenorrhea, dysmenorrhea, abnormal bleeding, and infertility in premenopausal women; postmenopausal women may be asymptomatic for long periods of time.

  • Suspect cervical stenosis based on symptoms and signs or on inability to obtain endocervical or endometrial samples for tests; inability to pass a 1- to 2-mm diameter probe into the uterine cavity confirms complete stenosis.

  • If symptoms or uterine abnormalities (eg, hematometra, pyometra) are present, exclude cancer by cervical cytology and endometrial biopsy or D & C, then dilate the cervix and place a stent.

* This is the Professional Version. *