Membranous Dysmenorrhea: An Underdiagnosed Condition

Dysmenorrhea is the most prevalent gynecological symptom in menopausal women. Currently defined as menstrual cramps, it is on the list of the main complaints in gynecological consultations. A sub-classification forgotten in medical dictionaries is membranous dysmenorrhea (MD), which corresponds to the elimination of membranes through the vaginal canal. The definitive diagnosis requires anatomopathological study, and abortion is the main differential diagnosis. As there are few cases in the literature, this study aims to present a series of eight cases, highlighting the pathophysiology and comparing the data with other studies to encourage discussion on the subject. This is an observational, longitudinal, retrospective study including women with clinical membranous dysmenorrhea (spontaneous elimination of fibroelastic material via the vagina). The results show that of the eight patients, seven had used or were using exogenous female hormones; 62.5% of the total had MD in the 2nd - 3rd decade of life, two had had previous abortions, and one was nulliparous. All these facts have been associated in the literature as etiological or contributing factors to MD. However, while diverging from the literature, our article showed that the infection factor is not mandatory for the occurrence of MD. In conclusion, proposing a single pathophysiological and etiological mechanism based on a series of cases and in comparison with other data in the literature is a challenge. However, consistently with what has been published, most of the cases presented were the result of an increased vascular response of the endometrium when exposed to an exogenous source of estrogen and progesterone, and this could be a hypothesis which, of course, requires further studies to establish the exact casuistry, but which contributes greatly as a source of data for future research.