OpenHealth Q&A

What Does Expelled Tissue During Menstruation Indicate: Decidual Cast or Not?

**Introduction:** I am a 29-year-old female who experienced the expulsion of atypical tissue during my menstrual cycle in February 2024. My gynecologist suggested it might be a decidual cast; however, I feel I did not fully convey the details regarding the tissue to my doctor, leading me to question this assessment based on its observed characteristics. **Birth Control Regimen:** - I have been using NuvaRing for a duration of 10 months, following a routine of three weeks in use and one week removed. - The tissue was expelled at the onset of my withdrawal bleed. - A urinalysis performed the following day—including a pregnancy test—yielded normal results. - A pelvic examination and transvaginal ultrasound (TVUS) two weeks later also returned normal findings. **Characteristics of the Tissue:** - The structure appeared distinctly tubular rather than flat or wrinkled. - It seemed to encompass a hollow core or lumen. - A vascular pattern was evident in its makeup. - Initially, the tissue was firm and retained its shape well. - By the following morning, though it appeared deflated, it still held its basic form with a rubbery texture. - Its coloration was a dark red to purple hue. - The tissue measured roughly 2 inches in length. **Situation and Symptoms:** - This incident coincided with a period marked by notable systemic symptoms. - Two weeks prior, I experienced tremors in my legs after climbing stairs in hot weather. - I also faced gastrointestinal issues, including chronic loose stools and nausea during this time. - There have been persistent neurological symptoms such as numbness in my extremities and difficulties with temperature regulation. - Furthermore, I've dealt with numerous vascular symptoms, including chilblains and livedo reticularis, alongside exercise intolerance. - The expulsion of the tissue was accompanied by the typical cramping associated with menstruation. **Health Background:** - I have symptoms that may indicate endometriosis, including pain during pelvic examinations behind my uterus, pelvic cramping after orgasm, and situational pelvic discomfort. - My family history includes several autoimmune diseases, such as ulcerative colitis and autoimmune hepatitis. - I have hypermobility and a homozygous mutation in the MTHFR gene. - Recent medical evaluations—like autoimmune panels, MRIs, EMGs, colonoscopy, and TVUS—have all returned normal results. **Inquiries:** 1. Do the features I described align with what experienced OB/GYNs would recognize as a decidual cast? 2. Is the timing of the tissue expulsion, alongside my systemic symptoms, of any significance? 3. Can a decidual cast maintain the tubular shape I observed instead of flattening like a sheet? 4. Should I be troubled by the vascular characteristics and the well-organized structure of the tissue? With the combination of my systemic symptoms and the distinct physical qualities of the tissue, I am contemplating whether this situation requires more thorough investigation, such as a laparoscopy, or if I might be overanalyzing a typical hormonal event. I appreciate any advice or thoughts on this matter!

Answers (1)

6/21/2025, 2:50:44 AM

OpenHealth AI

Thank you for sharing such detailed information about your situation. It sounds like you're feeling uncertain and looking for clarity on the tissue you expelled and its implications, especially in relation to your symptoms and possible endometriosis.

Main Points:

1. The features of the expelled tissue might suggest a decidual cast, but there are other possibilities.
2. The timing of tissue expulsion and your systemic symptoms are important to consider.
3. The shape of the tissue can vary, and organized vascular structures might warrant further discussion.

Explanation:

1. Decidual Cast vs. Other Tissues: A decidual cast usually appears as a sheet of tissue, often flat and may not have the tubular structure you observed. However, individual variations can occur. The normal pelvic examination and imaging tests you had are encouraging signs.

2. Timing and Systemic Symptoms: The fact that the tissue was expelled during your withdrawal bleed aligns with hormonal changes in your cycle, and your systemic symptoms, including nausea and tremors, could be related to a variety of factors, including hormonal fluctuations or other underlying conditions.

3. Shape and Vascular Characteristics: While decidual tissue is often less structured and more flat, what you described—a tubular form with vascular patterns—could potentially indicate other forms of endometrial tissue or a fibrous structure. Therefore, this could necessitate further evaluation to rule out conditions like endometriosis or other pathologies.

Next Steps:

• Keep a Symptom Diary: Document any changes in your symptoms and how they correlate with your menstrual cycle. This can help provide your healthcare provider with valuable information.

• Consult Your Gynecologist: Revisit your gynecologist with your findings and descriptions of the tissue. Present your concerns explicitly to ensure all aspects are considered, including your systemic symptoms and family history of autoimmune diseases.

• Consider Further Investigation: If your symptoms persist or worsen, discuss the option of further evaluation, such as laparoscopy, especially considering the possibility of endometriosis, which can often be diagnosed only through surgical intervention.

• Stay Informed: Research and learn more about the characteristics of abnormal menstrual tissues and related conditions. Resources from reputable organizations like the American College of Obstetricians and Gynecologists (ACOG) can provide reliable insights.

It’s completely understandable to feel anxious about these changes in your body. A detailed conversation with your healthcare provider is key to addressing your concerns and ensuring your well-being. Please reach out if you have more questions or need further clarification!