ost women are used to having vaginal bleeding or menstruation every month. A menstrual cycle, which usually lasts between 24 and 38 days, is part of the reproductive system. It is important, as it makes your body ready for a possible pregnancy. But imagine bleeding from your nose, eyes or lungs. Basically, the bleeding happens from spots outside the uterus during the menstrual cycle. While you may feel that this is because of an injury, it may actually have to do with vicarious menstruation. It is a relatively rare condition that can occur during your period.

What does vicarious menstruation mean?

Dr. Chetna Jain, an obstetrician and gynecologist, explains that this unusual medical condition involves menstrual-like bleeding happening from areas outside the uterus, aligning with the menstrual cycle. So, rather than just the usual vaginal bleeding, you might notice blood coming from places like your nose, eyes, lungs, skin, or ears.

What leads to vicarious menstruation?

Here are a few reasons that can lead to vicarious menstruation:

1. Shifts in hormones

As estrogen and progesterone levels change throughout the menstrual cycle, they can cause blood vessels to become more delicate and leaky, which might result in bleeding from areas outside the uterus. An expert explains, "Certain tissues outside the uterus can react unusually to these hormonal shifts, leading to bleeding in various parts of the body."

2. Endometriosis

Sometimes, endometrial tissue can grow in unusual places like the lungs and bladder, which is known as ectopic endometrial tissue. According to the expert, "This tissue reacts to estrogen and progesterone just like the lining of the uterus does, causing issues like bleeding in the lungs (thoracic endometriosis) or bleeding from the nose (nasal endometriosis)."

3. Delicate or irregular blood vessels

Certain women may have naturally fragile capillaries in areas like the nose, which can make them more susceptible to nosebleeds during their period. Dr. Jain explains that "hormonal changes can increase vascular permeability, resulting in bleeding from unexpected places."

4. Clotting issues in the blood

Dr. Jain explains that conditions like Von Willebrand disease, thrombocytopenia, and other bleeding disorders can increase the likelihood of unusual bleeding. If there’s an issue with clotting, menstrual bleeding could happen in unexpected areas, such as the gums and eyes.

What signs indicate vicarious menstruation?

Here are a few typical signs of vicarious menstruation:

• Regular or light nosebleeds during your period.
• Tears that are bloody or eyes that look red from bleeding in the conjunctival blood vessels.
• Coughing up blood if there’s an issue with your lungs.
• Swollen or bleeding gums when brushing your teeth, coinciding with your menstrual cycle.
• Blood seeping from the skin, which may show up as red spots or bruises.
• Blood coming from the ears without any injury or infection present.
• Blood in your stool or dark-colored poop during your period.

You might feel some pain or discomfort in the area that's affected. Dr. Jain mentions that "if the bleeding is significant and causes anemia, it can also lead to feelings of fatigue or dizziness."

What’s the process for diagnosing vicarious menstruation?

To identify vicarious menstruation, the following steps might be taken:

1. Health background

The doctor will inquire about:

• It's important to note when the bleeding happens to see if it aligns with your menstrual cycle.
• Also, consider where the bleeding is coming from, such as the nose, eyes, lungs, skin, or bladder.
• Lastly, any past issues with endometriosis, blood disorders, or clotting problems should be taken into account.

2. A physical check-up

• The affected area will be checked for any noticeable bleeding or lesions.
• If there's a suspicion of endometriosis, a pelvic exam will be performed.

3. Tests

Lab tests:

• Check hormone levels, such as estrogen and progesterone, to identify any hormonal imbalances.
• Also, look at the clotting profile, including platelet count, to eliminate the possibility of bleeding disorders.

Tests for urine and stool:

• If there's a suspicion of bleeding from the bladder or bowels, tests for blood in the urine and a stool blood test might be conducted.

4. Imaging examinations

To look for endometriosis or unusual tissue development:

• Ultrasound (both pelvic and transvaginal) is used to spot endometriotic cysts or unusual tissue growth in the reproductive system.
• MRI (Magnetic Resonance Imaging) offers a clear image of soft tissues, making it easier to find endometrial implants in areas like the lungs, nasal passages, bladder, or other locations.

What are some ways to manage vicarious menstruation?

The approach to treating vicarious menstruation varies based on what’s causing it.

• Birth control pills: According to the expert, "Combined estrogen-progesterone birth control pills can help balance hormones and reduce abnormal bleeding." A study from 2014, featured in Ophthalmic Plastic and Reconstructive Surgery, found that oral contraceptives were effective in managing vicarious menstruation.
• Non-hormonal medications: The expert notes that "Pain relievers like ibuprofen or naproxen can alleviate discomfort and inflammation associated with vicarious menstruation."
• Surgical treatment: Surgery is an option only if hormonal treatments fail to address vicarious menstruation. In cases where bleeding occurs in the lungs or bladder, the affected tissue may need to be surgically removed.

Occasionally, you might notice unexpected bleeding from unusual areas while on your period. This could be due to a condition called vicarious menstruation, which typically impacts women in their 30s and 40s. It's a good idea to see a doctor who can provide the appropriate treatment.

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