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Monday, May 19, 2014

Backwards Periods: Retrograde Menstruation Shown in the Culdesac of Douglas


Women think their menstrual flow should all flow 'out' of the body, in effect ridding the tissue and any potential toxins from the system. In fact some bleeding comes from the lining into the fallopian tubes and then into the pelvic cavity settling into the deeper areas of the pelvis including the posterior culdesac, or the very deepest portion of the pelvis located right behind the uterus. The culdesac or culdesac of Douglas as it was formerly known, shown here, has evidence of retrograde menses. The backwards flow of the uterus can also settle into the pelvic side walls and the ovaries as well as around the bladder. The blood contains some menstrual and tubal lining. The tissues that are bled through this backwards bleeding period itself may contain substances known as ,released from cell break down, which can cause cramping or bowel or bladder symptoms. The tissue is often mere fragments and it's relatively rapidly cleared out of the pelvis, but heavier bleeding will often result in blood being present in larger quantities for days. The tissue can implant on pelvic and abdominal structures and is be the cause of the development of endometriosis. Most likely it is not just the presence of blood, but the fact that the woman's immune system is not completely clearing the blood out of the culdesac. This is why very young adolescent girls do not have endometriosis: no periods, and why pregnancy and breastfeeding suppress additional endometriosis: no menstrual periods either! Patients taking steroid contraception (pills, the NuvaRing, the OrthoEvra Patch, Nexplanon, DepoProvera) will likely have light or no menstrual flow and also be protected in large part from developing or increasing the amount of endometriosis. If you have had an ultrasound that reported 'fluid in the culdesac' you may have abdominal cavity fluid, fluid from an ovarian cyst, or simple a backwards period. In any case, for the most part, it's very normal.

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