Neonatal Menstruation Explains Epidemiological Links between Fetomaternal Conditions and Adolescent Endometriosis

Ivo Brosens, Caroline E. Gargett, Stephan Gordts, Jan J. Brosens, Giuseppe Benagiano
In: Journal of Endometriosis and Pelvic Pain Disorders · 2015 · vol. 7(2) , pp. 51–55 · doi:10.5301/je.5000218 · W2189937838
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This systematic review of 1950-1984 literature indicates that fetomaternal conditions like postterm birth or preeclampsia are linked to neonatal menstruation, which may explain epidemiological links to adolescent endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This review evaluated literature (1950–1984) on neonatal menstruation and related fetomaternal factors, assembling 11 relevant publications (including 5,163 babies) to support a theory that neonatal endometrial progesterone withdrawal—analogous to adult menstruation—may seed early-onset endometriosis via retrograde transplantation of endometrial cells. The authors report that at birth the neonatal endometrium shows variable progesterone responsiveness (from absent responses to secretory activity, decidualization, and menstrual-like shedding), and that overt neonatal menstruation occurs in roughly 3.0%–5.2% of term births (typically days 3–7). Archival clinical data summarized suggest neonatal menstruation is rarer in preterm infants, more frequent in term/postterm infants, and associated with being born postterm and/or to a preeclamptic mother, while low birthweight may increase risk; however, they highlight limitations including manual search, incomplete theory development, and lack of accurate pregnancy dating in the archival studies. This paper is centrally about endometriosis — it proposes a neonatal menstruation–driven mechanism linking fetomaternal conditions to adolescent endometriosis risk.

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Abstract

Background Different fetomaternal conditions may influence the risk of endometriosis during adolescence and in adult life; here we focus on the hormonal maturation of the fetal endometrium in the final stages of pregnancy and on the theory that neonatal menstruation should be considered, similar to cyclic menstruation in the adult, as a risk factor for adolescent endometriosis. Methods The literature on neonatal menstruation and associated factors was systematically searched, and 19 relevant articles, published in different languages between 1950 and 1984, were retrieved. After closer scrutiny, 11 publications were selected as relevant. Results At birth, the neonatal endometrium displays different degrees of progesterone resistance, varying from a complete absence of progesterone responses, to secretory activity, decidualization and menstrual-like shedding. A temporal relationship exists between endometrial maturation and the incidence of neonatal menstruation, supporting the hypothesis that vaginal bleeding at birth is triggered by progesterone withdrawal. Neonatal menstruation occurs rarely in preterm babies, increases in those born at term and is a relatively frequent event in postmature infants. Analysis of archival clinical studies indicates that being born postterm or to a preeclamptic mother increases the risk of neonatal menstruation. Low birthweight may also enhance the likelihood of neonatal menstruation, whereas prematurity could be protective, although the available data are inconclusive. Conclusions The available data suggest that fetomaternal risk factors associated with neonatal menstruation could also potentially be useful in identifying women at risk of endometriosis. However, archival clinical studies have important limitations, including lack of accurate dating of pregnancy, therefore necessitating prospective studies and systematic registration of neonatal menstruation.

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endometriosis

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