Membranous dysmenorrhea: a complication of treatment for endometriosis

Appelbaum H, Heather Appelbaum
Obstetrics and gynecology · 2010 · vol. 116(2) , pp. 488–490 · doi:10.1097/aog.0b013e3181d4473c · PMID:20664428 · W2024342616
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-09 ⓘ

Norethindrone acetate treatment for endometriosis can paradoxically worsen pain and dysmenorrhea by inducing decidualization of the endometrium, a phenomenon termed membranous dysmenorrhea.

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This case report describes a 16-year-old patient with uterine didelphys and persistent endometriosis who developed severe colicky abdominal pain and expelled a decidual cast while being treated with norethindrone acetate. The authors attribute this condition, known as membranous dysmenorrhea, to an exaggerated decidualization reaction of the endometrium caused by high levels of progesterone therapy. They conclude that clinicians should maintain a high suspicion for this rare entity when symptoms worsen during progestin treatment for endometriosis. This paper is centrally about endometriosis — specifically detailing a complication arising from its medical management with progestins.

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Abstract

BACKGROUND: Progesterones are frequently used to treat endometriosis. Exaggerated response of the endometrium to high levels of progesterone can result in a decidualization reaction. Decidualization may cause an exacerbation of symptoms of dysmenorrhea associated with endometriosis. CASE: A 16-year-old girl with uterine didelphys and obstructed hemivagina presented with irregular bleeding and severe abdominal cramping after resection of the vaginal septum. Persistent endometriosis treated with norethindrone acetate resulted in severe colicky abdominal pain and expulsion of a decidual cast. CONCLUSION: Membranous dysmenorrhea can occur in response to excess progesterones. An understanding of the physiologic response of the endometrium to treatment will guide us to a high clinical suspicion of this rare entity when symptoms worsen in response to progesteronal treatment for endometriosis.
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Background

Progesterones are frequently used to treat endometriosis. Exaggerated response of the endometrium to high levels of progesterone can result in a decidualization reaction. Decidualization may cause an exacerbation of symptoms of dysmenorrhea associated with endometriosis. CASE: A 16-year-old girl with uterine didelphys and obstructed hemivagina presented with irregular bleeding and severe abdominal cramping after resection of the vaginal septum. Persistent endometriosis treated with norethindrone acetate resulted in severe colicky abdominal pain and expulsion of a decidual cast.

Conclusion

Membranous dysmenorrhea can occur in response to excess progesterones. An understanding of the physiologic response of the endometrium to treatment will guide us to a high clinical suspicion of this rare entity when symptoms worsen in response to progesteronal treatment for endometriosis.

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Condition tags

dysmenorrheaendometriosis

MeSH descriptors

Dysmenorrhea Norethindrone Progestins Adolescent Adolescent Dysmenorrhea Dysmenorrhea Endometrium Endometrium Endometrium Female Female Humans Humans Norethindrone Norethindrone Norethindrone Norethindrone Acetate Norethindrone Acetate Progestins

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Cites (4)

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License: CC0 · commercial use OK