Published: 2019-01-25

Recurrent decidual cast with membranous dysmenorrhea

Jyoti ., Suman Kumari, Devender Kumar, Pratiksha Gupta, Nupur Gupta, Anand Kumar


Decidual cast is the entire sloughed endometrium that takes the form of the endometrial cavity. It causes membranous dysmenorrhea because the intact cast passes through an undiluted cervix. It may be associated with ectopic pregnancy, incomplete abortion, non-pregnant state with use of progesterone, Depot medroxyprogesterone acetate (DMPA), rarely with oral contraceptive pills. Authors are reporting a case of recurrent decidual caste formation with membranous dysmenorrhoea in 33 years old women P3L3 who was on norethisterone acetate treatment for a typical uterine bleed (AUB). She presented with heavy menstrual bleeding with severe dysmenorrhea in Gynae causality of ESI Basaidarapur medical college, Delhi. She expelled decidual caste and required therapeutic Dilation and Curettage (D and C) to control bleeding per vaginum. Her histopathology report showed marked decidua like change of the stroma but no villi suggestive of endometrial caste.


Atypical uterine bleeding, Decidual cast, Membranous dysmenorrhea

Full Text:



Malik MF, Adekola H, Porter W, Poulik JM. Passage of decidual cast following poor compliance with oral contraceptive pill. Fetal Pediatr Pathol. 2015; 34(2):103-7.

Omar HA, Smith SJ. Membranous dysmenorrhea: a case series. Scient World J. 2007;7:1900-3.

Sen Y, Cimbek EA, Ugras NS. Decidual cast after discontinuation of oral contraceptives use in a young girl. J Pediat Adolesc Gynecol.2013;26(6):e127-9.

Appelbaum H. Membranous dysmenorrhea: a complication of treatment for endometriosis. Obstet Gynecol. 2010;116(2):488-90.

Asch RH, Greenblatt RB. Primary and membranous dysmenorrhea. South Med J. 1978;71(10):1247-9.

Greenblatt RB, Hammond DO, Clark SL. Membranous dysmenorrhea: Studies in etiology and treatment. Obstet Gynecol Survey. 1956;11(6):832-5.

Rabinerson D, Kaplan B, Fisch B, Braslavski D, Neri A. Membranous dysmenorrhea: the forgotten entity. Obstet Gynecol. 1995;85(5):891-2.

Maciel R, Rodrigues S, Inocêncio G, Saraiva J, Montalvão M. Membranous dysmenorrhea: a rare and unknown entity. Acta Obstet Ginecol Port. 2014;8(4):402-4.

Singh V, Talib N, Strickland J. Decidual cast in a girl receiving depot medroxyprogesterone acetate-a case report. J Pediat Adolescent Gynecol. 2007;20(3):191-4.

Oliveira PP, Eyng C, Zin RM, Menegassi J. Membranous dysmenorrhea: a forgotten disease. Brazil J Gynecol Obstet. 2009;31(6):305-10.

Rouanet JP, Daclin PY, Turpin F, Karam R, Prayssac-Salanon A, Courtieu CR, Maubon AJ. Imaging of membranous dysmenorrhea. Europ Radiol. 2001;11(6):952-4.

Torres A, Baszak-Radomańska E, Torres K, Paszkowski T, Staśkiewicz GJ, Wozniakowska E. A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment. Fertil Steril. 2009;92(5):1748-e5.

Veldman J, Van Houdenhove B, Verguts J. Chronic fatigue syndrome: a hormonal origin? A rare case of dysmenorrhea membranacea. Arch Gynecol Obstet. 2009;279(5):717-20.