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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.
“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.
Some of the causes of vicarious menstruation are:
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.
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.
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.
“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.
Here are some of the common symptoms of vicarious 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.
To diagnose vicarious menstruation, the following may be done:
The doctor will ask you about:
Blood tests:
Urine and stool tests:
To check for endometriosis or abnormal tissue growth:
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The treatment for vicarious menstruation depends on the underlying cause.
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.
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.
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.
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