Endometrial Tuberculosis and Secondary Amenorrhea: A Report of Three Cases in Sudan

Background: Female genital tuberculosis is an important cause of secondary amenorrhea and infertility in developing countries where tuberculosis is endemic. Objectives: We present three cases in which endometrial tuberculosis was a cause of secondary amenorrhea and infertility.\r\nPatients and Methods: In a retrospective study from January 2007 to June 2010, we conducted 1010 laparoscopies for infertile patients. Among these patients, three had secondary amenorrhea and infertility; therefore, they underwent hysteroscopy and endometrial biopsy.\r\nResults: The laparoscopic findings showed normal uterus and ovaries in all three patients; although the fallopian tubes were patent in one patient, they blocked in the other two. Hysteroscopy findings revealed that the endometrial layer was atrophied in all three patients, and biopsy results revealed the presence of acid-fast bacilli using Zeihl-Neelsen stain.\r\nConclusions: Patients with genital tuberculosis may have no documented history of tuberculosis or may have evidence of tuberculosis lesions elsewhere in the body. Histopathological evidence from biopsies of premenstrual endometrial tissue or demonstration of tubercle bacilli in cultures of menstrual blood or endometrial curetting is necessary to reach a conclusive diagnosis of the disease. When our patients were treated with antituberculosis treatment for 1 year they regained their menstruation but did not achieve pregnancy. Of note, if a patient conceives after genital tuberculosis infection, there is an increased chance of an ectopic pregnancy as a consequence of chronic salpingitis and tubal damage. Gynecologists in developing countries must consider genital tuberculosis as an important cause of tubal blockage and secondary amenorrhea that leads to infertility.