This is a detailed histological autopsy study of 47 cases of macroscopically recognisable flat intraendometrial haemorrhage into the atrophic lining of the uterine cavity. The average age of the studied women was 71 years. The majority of the deceased patients (61 %) had suffered from various cardiovascular diseases or acute abdomen; the rest had disseminated carcinoma, chronic lung, kidney or liver diseases. The most common cause of death was cardiovascular failure (68 %), followed by respiratory failure, cerebrovascular accident and renal or liver failure. We have observed serious vascular changes in other organs in 22 cases (46%), many of these affected the gastrointestinal tract. The histological examination has always showed congestion of the endometrium and myometrium. In 38 cases there was also marked haemorrhage into the endometrial stroma which occasionally extended into the myometrium. The intensity of the bleeding resembled a haemorrhagic infarction in several instances. The myometrial arteries exhibited a variable degree of atherosclerosis with narrowing of their lumen. In our opinion, apoplexia uteri is caused by the state of permanent hypoperfusion leading to passive hyperaemia, and it is related to the degree of the arterial stenosis.

        Key words: atrophic endometrium – postmenopausal bleeding – circulatory failure – passive hyperaemia – stress