A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment

Passage of Decidual Cast Following Poor Compliance with Oral Contraceptive Pill

“…The presence of progesterone is the common denominator in most of the aforementioned hypotheses. This is consistent with all reported cases where the use of hormonal contraception or pregnancy (which also increases serum progesterone significantly) was associated with this clinical finding [6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…The case series by Omar et al reports three out of six patients were on DMPA prior to expulsion of decidual casts [12]. Also in that case series and in other reports, decidual casts can result from transdermal patch and oral contraception pill use [6,12,14,18] like in our case. The difference here is that unlike other studies where a decidual cast occurred while using progesteronecontaining hormonal contraception; ours was associated with brief stoppage of said medication.…”

“…It is a rare clinical presentation with about 20 cases reported in the literature [6][7][8][9][10][11][12][13][14][15][16][17][18]. Mostly reported as a side effect of progesterone containing hormonal contraception [6,12,[14][15][16]18], it is also a potential cause of antepartum bleeding in pregnancies with Mullerian anomalies [11,17,19,20]. It has also been described in ectopic pregnancies with the grave potential of mimicking an intrauterine pregnancy in these cases [8][9][10]13].…”

“…Whether this was coincidental is uncertain. It is interesting to note that all reports of decidual cast in association with exposure to progesterone-containing hormonal contraception have been restricted to postmenarchal adolescents [6,12,14,16,18]. Further research is needed to investigate the restriction of this complication to this age group.…”

Spontaneous Membranous Dysmenorrhea in an Adolescent Girl: A Case Report and Literature Review

“…A review of the literature revealed about 21 cases of MD (1)(2)(3)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and it is interesting that two of 21 cases (9.5%) had congenital anomalies that included microcephaly, congenital deafness, profoundly delayed psychomotor and language development, seizure disorder that is well controlled with clonazepam (12), and cerebral palsy, epilepsy, and mental retardation (case 1 of the reference) (13). We think that these two patients reported with MD, who had congenital anomalies is just a reflection of the fact that more and more girls and women with these significant anomalies are managed with DMPA.…”