BACKGROUND:

Endometrial osseous metaplasia has an estimated incidence of 3 cases per 10,000 women and there are few reported cases. Symptoms are nonspecific: chronic pelvic pain, abnormal uterine bleeding, dysmenorrhea and dyspareunia. Most patients suffer from primary or secondary infertility. There are different theories of its pathophysiology. Two-dimensional endovaginal pelvic ultrasound plays a decisive role in the diagnosis; most cases are an incidental finding with a typical structure mimicking an intrauterine device.

CLINICAL CASE:

47-year-old female patient, in perimenopause, with chronic pelvic pain and abnormal uterine bleeding. She came for consultation with a translocated intrauterine device, noticed in the routine gynecological ultrasonography, with an apparent history of having had it removed 21 years ago. During the examination the reins of the IUD were not observed. Office hysteroscopy showed endometrial bone metaplasia; the bone fragments were removed, and her symptoms subsided. She continued to be followed up in the climacteric clinic for treatment of perimenopausal symptoms.

CONCLUSIONS:

Endometrial bone metaplasia is rare, with very few cases reported worldwide, perhaps because it is underdiagnosed. The pathophysiology is still unclear, although its different theories are accepted. It should be suspected in patients without an intrauterine device, in the presence of ultrasonographic findings compatible with its location, associated with abnormal uterine bleeding and chronic pelvic pain. Most of the reported cases are associated with infertility. The definitive diagnosis and treatment is with office hysteroscopy, with grasper or hysteroscopic resectoscope.