What could be the reason for shedding fleshy piece regularly during third day of menstrual cycle?
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Hello I am a 28 year female. I have a regular 29 day cycle and period length is 7 days. The first two days I experience moderately heavy bleeding with moderate cramps (nothing too uncomfortable). On the third day, I shed a fleshy piece, which I believe is "decidual cast" (from internet search). A few hours before this shedding, I experience slightly heightened cramps (but again, nothing too painful) and the cramps subside after the release of this "tissue/fleshy matter". This tissue is red in colour and has a uterus like shape. I experience this shedding every month, consistently on the third day, ever since my periods started. Other than that I don't experience any other symptoms like excessive abdominal pain, back pain, irregular or missed periods. My questions to you are - 1. Is this shedding normal? 2. Also, I shed it during every cycle - what causes that and is there a cause for concern? 3. Should I see a doctor and get any tests done in this regard? 4. I am not on birth control pill. My husband and I use condom for protection. So far we have no tried for conception but will this affect my fertility in future? 5. Any other precautions/ suggestions that you can give me in this regard. Thank you.
Posted Mon, 23 Dec 2013 in Pregnancy
Answered by Dr. Aarti Abraham 42 minutes later
Brief Answer: DECIDUAL CAST EACH MONTH IS NOT NORMAL. Detailed Answer: Hello Thanks for writing to us with your health concern. I would be glad to assist you with this matter. To answer your questions in the order in which you have asked - 1. The shedding of a decidual cast each month is not ' normal '. Every menstrual cycle, the lining of the uterus that has built up each month, gets shed off. When the lining grows to a particular level, the hormone pattern changes, and menstruation occurs. A decidual cast consists of excessively overgrown ( thickened ) lining of the uterus. Hence, this indicates overgrowth of the lining ( endometrium ). Technically speaking, this condition is called endometrial hyperplasia. If normal periods are occurring, this ' cast ' should not be shed every cycle. 2. Regarding the causes, I told you that the basic problem is endometrial hyperplasia. THis indicates underlying hormonal imbalance. The most common reason for such cast shedding every cycle is - polycystic ovarian disease. In this condition, the ovary is studded with multiple small follicles ( cysts ) - the hormones go awry and normally cycles are irregular, and the endometrium often thickens and builds up, leading to a decidual cast each cycle. In the absence of PCOD, there might be simple endometrial hyperplasia - which leads to heavy overgrowth of the lining each month. 3. Yes, you should consult a gynaecologist for an evaluation. First of all, ultrasound scan should be done, preferably midcycle ( in the middle of your period ) to document the endometrial lining. If it is beyond 10 - 12 mm, then it needs further investigation. This should be in the form of an endometrial biopsy done just premenstrually. It is a simple 2 minute office procedure done without anesthesia . It will reveal the problem present in the endometrium. Alongside this, other blood tests should be done - Complete blood count Bleeding profile Clotting tests FSH, LH on day 2 of cycle TSH, Prolactin OGTT, lipid profile DHEAS, free testosterone Baseline ultrasound on day 2 of period. This workup will reveal the presence of ( any ) PCOD or other abnormalities. 4. If any condition such as PCOD or other hormonal imbalance is identified, yes, it can impact your fertility. But the treatment can be tailored as per the disease identified. Do not worry, as none of these conditions are life threatening or totally incompatible with fertility. 5. Please maintain an ideal body weight. Take regular folic acid supplements 3 months before planning a pregnancy. Maintain a menstrual calendar, keeping track of your cycles. If a problem is identified, stop using condoms and do not delay conception any further. Rather, try and get pregnant early. Apart from the workup which I suggested , nothing specific needs to be done. Take care. Please feel free to ask for further clarifications.
Follow-up: What could be the reason for shedding fleshy piece regularly during third day of menstrual cycle? 39 minutes later
Thank you for your detailed answer. I will visit a Gynaecologist soon and get the suggested tests done. My follow up questions are - 1. If I am diagnosed with PCOD - what kind of treatments are available for it? Can it be "cured"? 2. If I am NOT diagnosed with PCOD, you said it might be simple endometrial hyperplasia. In that case what is the line of treatment? 3. Apart from PCOD and endometrial hyperplasia - are there any other conditions which may be associated with it? Thank you.
Answered by Dr. Aarti Abraham 1 hour later
Brief Answer: DETAILED BELOW Detailed Answer: Hello Thank you for your appreciation. 1. It is strange, that you have used a pet statement of mine - often quoted in medical literature - PCOD has no ' cure '. It is a metabolic disorder, and can only be controlled. The menstrual irregularities will respond to drugs / weight loss, as will the ovulatory problems, so as such it is not a fatal or serious disease that requires a ' cure '. As far as treatment options are considered - weight loss and lifestyle management is the keystone. Even a 5 % weight loss ( if you are overweight / underactive ) will result in significant improvement. Drugs like Metformin are further given to help in symptom control. If fertility is an issue ( often is, with PCOD ) - drugs are given to induce ovulation - such as clomiphene citrate. SO basically symptomatic treatment is given. IF your cycles are regular and ovulation is normal ( this too can happen with PCOD ) - then often no treatment is required. 3. With simple endometrial hyperplasia, a biopsy is essential to know the type of hyperplasia - different types exist, which are differentiated on the basis of biopsy . The treatment is generally cyclical hormone therapy ( progesterone given for fixed days each month ) - within 2 - 3 months, generally this is corrected. 3. WOmen who use oral contraceptive pills, or use fertility enhancing medications, often develop such decidual casts. A miscarriage obviously causes expulsion of such decidual casts. Other than that, membranous dysmenorrhoea is a condition associated with it. In this, there is severe pain and cramping during periods, associated with passage of such casts. This too develops commonly in women using OC pills. All the best. Please feel free to discuss further.
Follow-up: What could be the reason for shedding fleshy piece regularly during third day of menstrual cycle? 10 hours later
Thank you for your in-depth response. The surprising thing is that I've experienced this situation since the very beginning of my periods and I always treated the monthly shedding as something very normal which other women experience too. For some reason yesterday, of all the months and years, I had the urge to find out if this is "normal" or not. I have always had regular periods (never skipped, 99% on time, at times may be delayed or pre-poned by 1-2 days). I also never felt the bleeding or cramping was that heavy so as to interfere with my normal routine (except that I may feel like I need to rest for a few hours on day 1). Additionally, I am not overweight (height 5'7" weight 63 kg) and lead an active lifestyle (exercise for 30 minutes 5 days a week, no smoking, no drinking, vegetarian). In fact one of the reasons why I chose to seek online consultation is because I work in a rural area where medical facilities are not too good and it would a while before I visited the city to meet a gynaecologist. So, on the surface of it, I feel like I don't show most classical symptoms (except for this monthly shedding) and therefore it was really surprising to know that I may potentially have pcod or endometrial hyperplasia. Do you think some of these things may be genetic? Because from my end I have tried to lead a healthy lifestyle as much as possible and was wondering why I might (if tests reveal that I do) have these hormonal imbalances in the first place. But atleast this way I would get the tests done and know the status. Thank you again for your time.
Answered by Dr. Aarti Abraham 2 hours later
Brief Answer: DETAILED BELOW Detailed Answer: Thank you once again for your kind words of appreciation. It is a pleasure on my part to interact with a particularly knowledgeable and insightful person. That is what has baffled me in your case - that the cast has been happening EVERY cycle, since your periods began. I have never come across such a presentation. And I agree, that going by your history, I would not suspect any condition that was not normal in you. You do not fit into the PCOD picture, nor do you have excruciating pain or extremely heavy bleeding ( that could fit with endometrial hyperplasia ). SO I agree with your summary of the situation. HOwever, a decidual cast is definitely not something normal, and the investigations would not hurt, particularly as you have conception looming somewhere in the future too. In rare instances, yes, it could be genetic, though it is unheard of. If you turn up with normal results, you would be a rare story ! There is no hurry to get the tests done, as you are completely asymptomatic and healthy. Try and schedule an appointment with a reputed doctor and a reliable laboratory as much will depend on the lab results. Again, please get the ultrasound done transvaginally ( not abdominally - very pure resolution ) and get it done midcycle or premenstrually to know the presence of endometrial hyperplasia. I would love to know about the results, as your symptoms have got me interested too. I have never heard of a patient who passes decidual casts each monthly cycle, without any causative factor. All the best to you, and wish you good health. You can contact me directly anytime you wish to connect, using the following link - WWW.WWWW.WW Take care.
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