Women experience a menstrual cycle every month, complete with familiar symptoms such as abdominal pain, fatigue, and mood swings. But what if these aches are due to the lesser-known phenomenon called Retrograde Menstruation? Surprising as it may sound, around 90% of menstruating women experience some level of backward menstrual flow.

Let’s dive into what this means, how common it is, and when it might become a concern.

Understanding the Menstrual Cycle

The uterus prepares for a possible pregnancy each month by thickening its lining. If fertilization doesn’t occur, this lining breaks down, and menstruation begins, allowing blood and tissue to exit through the cervix and out of the body via the vagina.

What Is Retrograde Menstruation?

The term retrograde implies “moving backward.” In retrograde menstruation, menstrual blood doesn’t only flow outward through the cervix but reverses, moving up through the fallopian tubes into the pelvic cavity.

When menstrual blood spill onto the peritoneum does the patient experience pain, or is this a ‘clinically silent’ event?

This backward flow is typically harmless and part of a normal menstrual cycle. But in some cases, it can trigger painful symptoms and lead to conditions like endometriosis.

Dr. Sampson (1921) suggested the theory of retrograde menstruation. Subsequently, it accounts for endometriosis and even endometrioid carcinoma of the ovary.

Here is Dr Karan Rajan (MRCS MBBS BSc), NHS Surgeon, explaining it to Ms. Nadya Okamoto, Co-founder of Period Movement.

How Common Is Retrograde Menstruation?

Retrograde menstruation is surprisingly common among women. However, it only becomes a potential issue when it occurs in excess, causing symptoms or contributing to the development of conditions like endometriosis.

What Is Endometriosis?

Endometriosis occurs when endometrial cells, which normally line the uterus, implant and grow outside of it, often in the pelvic cavity. In some women, the immune system clears these misplaced cells naturally, but in others, the cells persist, causing inflammation, scarring, and tissue damage.

Endometriosis symptoms may include:

• Chronic pain

• Inflammation in the pelvic area

• Scarring of reproductive organs

• Potential fertility challenges due to reproductive organ damage

What Causes Retrograde Menstruation?

The exact causes remain uncertain, though several factors may contribute:

• Anatomical Abnormalities: A narrow cervical opening can increase the likelihood of backward flow.

• Genetic Factors: Genetics may predispose certain individuals to experience this phenomenon more intensely.

While retrograde menstruation is common, it is typically asymptomatic, so most women will never notice it. However, for some, symptoms like painful menstruation (dysmenorrhea) may arise due to irritation caused by blood in the pelvic cavity.

Recognizing Symptoms and Diagnosis

Because menstrual discomfort is often multifactorial, diagnosing retrograde menstruation can be tricky. However, for individuals experiencing severe cramps, intense abdominal spasms, or heavy bleeding (menorrhagia), a healthcare professional might consider retrograde menstruation as a potential factor.

Diagnostic Approaches: Retrograde menstruation itself is rarely diagnosed as an isolated condition. Instead, it may be identified during evaluations for pelvic pain or endometriosis. Physicians often use laparoscopy, a minimally invasive procedure, to inspect the pelvic cavity for blood or misplaced endometrial tissue.

Treatment Options

There is typically no treatment specifically for retrograde menstruation, as it’s usually a normal and harmless process. However, if it contributes to conditions like endometriosis, treatments may target symptom management and inflammation. If you’re facing intense menstrual pain or unexplained symptoms, consult a healthcare provider for guidance.

Summary

Retrograde menstruation is a common but overlooked phenomenon, with most women experiencing it. It is just that when on period, some of the blood and tissue spill backward instead of onto the pad, cup, or tampon. While typically harmless, it can occasionally lead to health complications like endometriosis. If you experience severe menstrual pain or symptoms that affect the quality of life, you better seek a healthcare professional.

By shedding light on these “hidden” aspects of menstruation, we can better appreciate and manage the intricacies of reproductive health.

Reference:

1.     Halme J, HAMMOND MG, HULKA JF, RAJ SG, TALBERT LM. Retrograde menstruation in healthy women and in patients with endometriosis. Obstetrics & Gynecology. 1984 Aug 1;64(2):151-4.

2.     D’Hooghe TM, Debrock S. Endometriosis, retrograde menstruation and peritoneal inflammation in women and in baboons. Human reproduction update. 2002 Jan 1;8(1):84-8.

By Josna Lewis