Almost every woman experiences vaginal menstrual flow every month. However, sometimes you may bleed from your nose, eyes, and lungs. It may be due to vicarious menstruation.
Most 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 is vicarious menstruation?
“It is a rare medical condition where menstrual-like bleeding occurs from extragenital sites or outside the uterus in sync with a menstrual cycle,” says obstetrician and gynaecologist Dr Chetna Jain. This means that instead of or in addition to normal vaginal bleeding, you may see blood coming out from your nose, eyes, lungs, skin or ears.
It usually occurs during menstruation or within 48 hours of its onset, as per research published in GMS Ophthalmology Cases in 2023. It usually affects women in their 30s or 40s, as per research published in BMJ Case Reports in 2021.
What are the causes of vicarious menstruation?
Some of the causes of vicarious menstruation are:
1. Hormonal changes
When estrogen and progesterone fluctuate during the menstrual cycle, they can make the blood vessels more permeable and fragile, leading to bleeding from non-uterine sites. “Some tissues outside the uterus may respond abnormally to these hormonal changes, causing bleeding from different parts of the body,” says the expert.
2. Endometriosis
In some cases, ectopic endometrial tissue (endometrial-like tissue growing outside the uterus) may be present in body parts like the lungs and bladder. “This tissue bleeds in response to estrogen and progesterone, similar to the uterine lining, leading to symptoms such as lung bleeding (thoracic endometriosis) or nasal bleeding (nasal endometriosis),” says the expert.
3. Fragile or abnormal blood vessels
Some women have naturally weak capillaries in certain areas such as the nose, making them more prone to nosebleeds during period. “Increased vascular permeability due to hormonal changes can also lead to bleeding from unexpected locations,” says Dr Jain.
4. Blood clotting disorders
“Conditions such as Von Willebrand disease, thrombocytopenia or other bleeding disorders can make a person more prone to abnormal bleeding,” says Dr Jain. If there is a problem with clotting, menstrual-related bleeding might occur in unusual places like the gums and eyes.
What are the symptoms of vicarious menstruation?
Here are some of the common symptoms of vicarious menstruation:
- Frequent or mild nosebleeds during menstruation.
- Bloody tears or redness in the eyes due to bleeding from conjunctival blood vessels.
- Coughing up blood if your lungs are affected.
- Gums becoming swollen or bleeding while brushing teeth, in sync with periods.
- Blood oozing from the skin, sometimes appearing as red spots or bruises.
- Blood discharge from the ears without any injury or infection.
- Blood in the stool or black poop during menstruation.
You may also experience pain or discomfort in the affected area. “Bleeding may be accompanied by fatigue or dizziness, especially if bleeding is heavy and leads to anemia,” says Dr Jain.
How is vicarious menstruation diagnosed?
To diagnose vicarious menstruation, the following may be done:
1. Medical history
The doctor will ask you about:
- Timing of the bleeding to know if it occurs in sync with your menstrual cycle.
- Location of the bleeding like the nose, eyes, lungs, skin, and bladder.
- Any history of endometriosis, blood disorders, or clotting issues.
2. Physical examination
- Examination of the affected area will be done for any visible signs of bleeding or lesions.
- Pelvic exam will be conducted if endometriosis is suspected.
3. Tests
Blood tests:
- Hormone levels (estrogen, progesterone) to check for hormonal imbalances.
- Clotting profile like platelet count to rule out bleeding disorders.
Urine and stool tests:
- If bladder or bowel bleeding is suspected, tests for blood in urine and stool blood test may be done.
4. Imaging tests
To check for endometriosis or abnormal tissue growth:
- Ultrasound (pelvic and transvaginal): Detects endometriotic cysts or abnormal tissue growth in the reproductive organs.
- MRI (Magnetic Resonance Imaging): Provides a detailed view of the soft tissues, which can help to identify endometrial implants in the lungs, nasal passages, bladder or other places.
How to treat vicarious menstruation?
The treatment for vicarious menstruation depends on the underlying cause.
- Birth control pills: “Combined estrogen-progesterone birth control pills can help regulate hormones and suppress abnormal bleeding,” says the expert. A 2014 study, published in Ophthalmic Plastic and Reconstructive Surgery, showed that oral contraceptive pills helped in treating vicarious menstruation.
- Non-hormonal medications: “Medications like ibuprofen or naproxen can reduce pain and inflammation that may happen during vicarious menstruation,” says the expert.
- Surgical treatment: Surgery is considered only if hormonal therapy does not help to treat vicarious menstruation. If bleeding occurs in the lungs or bladder, the affected tissue may be surgically removed.
Sometimes, you may experience unexplained bleeding from unusual sites during your period. It may be because of vicarious menstruation, which usually affects women in their 30s and 40s. Consult a doctor who can offer you the right treatment.
Related FAQs
Is nosebleed a sign of your period coming?
Yes, in some cases, nosebleeds can be a sign of your period coming, though they are not a common symptom for most women. This condition is linked to hormonal fluctuations during the menstrual cycle and, in rare cases, may be a form of vicarious menstruation where menstrual-like bleeding occurs outside the uterus.
Is there a connection between vicarious menstruation and endometriosis?
Yes, vicarious menstruation and endometriosis are often closely linked. Endometriosis is a condition where endometrial-like tissue grows outside the uterus, responding to hormonal changes in the menstrual cycle. This abnormal tissue can bleed cyclically, just like the uterine lining, leading to bleeding from non-uterine sites, which is a sign of vicarious menstruation.
