Decidual Casts & Birth Control

Content Warning: Sensitive content and images are shared in this blog – discussing blood, menstruation, and period pain. I’ll place the sensitive content lower in this blog post with a few warnings throughout so you have a few chances to avoid it.

Okay, so now that the content warning is out of the way – if you are still reading this – I want to talk about my experience with birth control, painful periods, and more specifically, decidual casts.

Don’t worry if you don’t know what a decidual cast is – I didn’t either until I experienced one.

Now, having had a period at least 12 times a year for the last 19+ years (give or take), I have never heard about decidual casts and I have never experienced one myself, until this month.

Some background – I have had painful periods my whole life. I’m used to a full, 7-day cycle and I have dealt with taking birth control to help make them less painful, make them lighter, and keep them on a regular schedule. I have been doing this since I first got my period – even before I began having sex.

I have dealt with irregular periods for the longest time, too, with cycles ranging from 20 days to 45 – and sometimes with mid-cycle bleeding to boot. I have continued to track my periods on the same app since early 2013 and I see my Primary Care doctor regularly for my issues. When I have weird or irregular periods, she usually prescribes me a 3 month supply of birth control to help regulate my cycle.

I also suffer from ovarian cysts, which can lead to painful periods and cramping. The birth control is also supposed to help with fewer cysts and PMS symptoms. I have mentioned these issues in older blog posts but they have been put on the back burner for years.

During this last 3-month cycle – I used the same birth control I have used for years – the NuvaRing. I pop it in, let it sit for 3 weeks, remove it, and my period arrives. Then, 7 days later, I repeat the cycle.

But this time, after my first of three rings, I had a continuous period with spotting and irregular bleeding for over 45 days. I couldn’t tell which bleeding was my period and which was just my body wonking out – so I skipped putting in my ring until the spotting seemed to stop.

I made an appointment with my Primary Care doctor to talk about the excess bleeding for 45+ days, we discussed my current cycle, and she put in a referral for a transvaginal ultrasound. I have had a few transvaginal ultrasounds before – usually every few years or when my period really goes haywire, and I am really glad my doctor put in the order for one – even before the decidual cast – so maybe the ultrasound can shed some light on it and my wonky periods and will help see if any decidual tissue was left behind.

She also suggested doing 3 weeks with one NuvaRing – and instead of removing and having another period, I was told to immediately get a new ring and use it – skipping the next period and bringing my cycle back to normal after the next 3 weeks with the second ring.

When I finally felt like the spotting was ending, I began my second month with my NuvaRing, and by the end of those 6 weeks when the second NuvaRing was removed, I immediately started to have my period again – but, I was at least back on schedule.

Now, I know I haven’t told you about the decidual cast just yet – but bear with me – I am trying to keep those details a little lower in the post since it is pretty gory, and adding a little background of what happened to me never hurts.

I mentioned having painful periods, but something about this one was different. I hurt, and I mean I HURT HURT. By day 3 of my cycle, I felt like I had pulled muscles or slipped discs in my lower back. I was wearing Lidocaine patches for days and laying with my heating pad on me trying to not feel bad.

I had to rotate my heating pad and put it on my back for a while and then on my stomach – as I was having the worst cramps I think I have ever had. The pain was so bad that I was getting nauseated and chills as the cramps seemed to come in waves, each worse than the last.

I wasn’t feeling too good that whole 3rd day of my cycle, but of course, I had to do everyday things like cook dinner. This is where things get TMI. You’ve been warned.

If you’re a menstruating person, you know that feeling on your period when you just feel ‘wet’ down there and you know when fluid or tissue exits your body. I’m not one for tampons, so I know that ‘wet’ feeling of a liner and I know when I need to change my period product.

And like I said before – something about this period was different. I felt something unusual as I stood there in my kitchen trying to cook dinner. I felt like I had lost A LOT of blood, all at once, and I needed to investigate as soon as possible.

When I got to my bathroom, I pulled my pajama pants and panties forward to kind of have a look ‘down there’ and I see something pink, fleshy, and what I considered absolutely not normal.

This thing had come from inside me and I didn’t know what I was looking at. I felt sick. I had chills. Mind you, I was only seeing a portion of this thing.

So, I pull down my bottoms and get myself seated in the bathroom. Looking at my liner, I was confused and worried about what this thing was. It was large, fleshy, and pink with hints of dark red, almost black tissue. It was nothing I had ever seen before or ever heard about.

I took some pictures of it (below) and began to Google like crazy trying to figure this thing out. I had hurt all day, I was mid-cycle, and this thing was larger than any clot that I had ever seen come out of me. I thought something was wrong.

Luckily, nothing was wrong, at least I don’t think. I will need to schedule with my Primary Care after I have my transvaginal ultrasound this upcoming week. I will make sure I share the photos I have of the cast with her and get her opinion on what it is. But, with enough research and Googling trying to find other people’s pictures for comparison – that’s how I found out it was probably something called a decidual cast.

Now, what is a decidual cast? A decidual cast, sometimes called an endometrial cast, is a large, fleshy piece of the decidual lining. Usually, when you menstruate, it happens in drops or little by little. With a decidual cast, a large piece comes out all at once. In order for the tissue to leave the body, it passes through an undilated cervix, and this can cause pain as it exits your body.

Now, with my research – I have found that this isn’t necessarily a bad thing, but pretty rare. Considering that I knew there was no chance of pregnancy for me, I don’t believe I have to worry as much. As always, if you are pregnant and bleeding, you should let your healthcare provider know. With this blog, I am not intending to give medical advice, just my patient perspective.

I have Googled the hell out of decidual casts for the past 2 weeks, reading health blogs, medical journals, and trying to find similar situations with others. And, from what I gather, this can happen with ectopic pregnancies – where the pregnancy occurs outside of your uterus. It can also happen when taking birth control pills or using other birth control methods that contains progesterone, which is probably true for me.

I have been on the NuvaRing for years, off and on, and I can honestly say I never knew about the risk of having decidual casts. I have never had one, and I did not know something like this could happen.

It was painful, I felt ill, and I was miserable for days until the tissue exited my body. I did still have cramping and bleeding once the cast was out, but my pain and symptoms were much less in the days that followed.

I am due for my transvaginal ultrasound in a few days, as I mentioned above, and I am currently on my 3rd cycle of the NuvaRing – one week in. I do have a continuing prescription this time, with another 3 months to follow, but I will make the decision to continue only after I see if this happens to me again this month.

I will try to update you all as soon as I get my ultrasound results and a follow-up with Primary Care. I am hoping that I don’t get another this month, but I guess I will find out. I will tell you, the pain was so surreal that I feel like I will know immediately if it is happening again.

I know this post has been a little TMI but I feel like decidual casts, although rare, should be discussed when talking about reproductive health, painful periods, and contraception side-effects.

For now, It Could Be Worse.

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Slipping Rib Syndrome & Bridging Cartilage Fracture

2023 – Let’s Catch Up