What’s Going on Down There? Decidual Casts
Antonia Jenkinson
No, I don’t mean Australia. Welcome to our newest blog series called ‘What’s Going on Down There?’ where we’ll be dissecting some of the more unusual, but not uncommon, period symptoms. My combination of health anxiety, and a conservative sex education that barely covered the use of a condom, I get easily freaked out when I think something might be wrong. There are so many things that the British education system aren’t obligated to teach us about getting our periods, from UTIs, to ovarian cysts, which affect a huge portion of menstruators. This series will do its best to provide you with top quality information, and hopefully put your mind at ease, about some lesser known afflictions which come with a period. We’re kicking the series off today with a decidual cast…
What’s going on down there?
Let’s find out!
Back in my first year of university, sat on the toilet in my ground floor student halls bathroom, I rang my mum. Just 2 minutes before I had some really bad cramps and was in considerable amounts of pain. Given that I was on my period, I went the loo to change my tampon to see if this might reduce the pain I was in. Looking down at the toilet roll, I noticed a triangular wad of fleshy tissue about the size of my palm had come out with blood from my period.
I was terrified. Every worst nightmare I had was suddenly coming true in my eyes; I’d started giving birth to a secret pregnancy on the toilet of my uni accommodation; I had something really wrong with me and I was going to bleed out; had I just miscarried? None of these questions my mum could answer to calm me down. I rolled up the underwear I had been wearing at the time and put it into a freezer bag, ready to transport to A&E.
Being a young woman in A&E alone can be frightening. This was the first time I had ever been into hospital without a guardian as I had turned 18 a few months ago, and covid restrictions in 2020 meant I couldn’t take anyone in with me. Maybe it was my age, the deer in headlights look, or shaking trying to explain what had happened to me, but the doctors at Queen’s Medical Centre were careful to treat me with empathy and kindness.
So, what exactly is a decidual cast?
After I had bloods taken and a brief assessment, a gynaecological specialist sat down with me and explained that I had experienced passing a decidual cast. She explained that a decidual cast is when the body expels a large piece of uterine tissue at one time, rather than breaking it down and tissue coming out with the blood. I was told that the pain I had experienced was normal for a decidual cast, as the cervix often contracts to 1 or 2 centimetres to allow the tissue to pass into the vaginal canal. Typically, decidual casts are not harmful medically, and are thought to be linked to hormonal contraception, which made sense to me as I was taking the combined pill at the time. While hormonal contraception can be linked to decidual casts, if you are taking contraception you are not putting your body at risk - a decidual cast is a rare, but completely harmless, side effect. However, unfortunetly the cause of a decidual cast is largely unknown, and most research compiled about them is mostly speculative.
The gynaecologist explained to me that occasionally decidual casts can be caused by ectopic pregnancies, and miscarriage, which is why I had to have bloods taken, as leaving both of these possibilities untreated can be extremely dangerous to patients. Fortunately for me, neither of these was the cause, and the doctor explained that passing a decidual cast was a very normal, and common, experience for women taking hormonal contraceptives. She also made sure to mention to me that once a person has experienced passing a decidual cast, it is highly unlikely it will happen again. She was sure to tell me that decidual casts have no lasting impacts on health or fertility, but just were an unfortunate part of menstruation for some people.
Arriving home, I treated my period as normal. I made sure to get rest due to the stress I had just been through, and took painkillers as the inflammation of my cervix went down. Luckily, patients who experience decidual casts often must just rest, although prescription medicaiton can be provided for extreme pain.
The severe underfunding of women’s health led to a terrified 18-year-old me sat crying in a hospital room on my own, completely in the dark about what was happening to my body. The kindness I was met with during my brief visit to QMC inspired me to make myself, and others, aware of different menstrual conditions that are unusual, but not uncommon. I hope that this blog post has reassured you if you, or anyone you know, might have experienced passing a decidual cast. It is common that passing a decidual cast often leaves women not seeking help out of embarassment. While I hope that this post has relieved any anxiety concerning the topic, I also wish to convey with passion that your health matters and you should feel freely able to seek help for any concern, even if you are worried about it being embarassing.