Decidual Cast: What Is It, Symptoms, And When To Seek Help

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HealthlineSubscribeWhat Is a Decidual Cast?

Medically reviewed by Fernando Mariz, MD — Written by Natalie Silver — Updated on May 2, 2022

Symptoms
Causes
Diagnosis
Risk factors
Getting help
Prevention
Outlook

Passing a decidual cast happens when your body sheds the entire lining of the uterus as one piece. You may experience bleeding and severe cramps, among other symptoms. Some causes may require emergency medical treatment.

What is a decidual cast?

A decidual cast is a large piece of tissue that passes through your vaginal canal.

Once the tissue is outside your body, you may notice that it looks like the shape of your uterus. This condition can affect people who menstruate. The decidual cast can cause extreme discomfort as well as vaginal bleeding as it leaves your body.

Generally, symptoms related to this condition go away after the decidual cast exits the body if it’s not related to another condition. There isn’t a single known cause of a decidual cast, but it may be related to hormonal contraception or ectopic pregnancy.

Read on to learn more about decidual casts, including symptoms, when to get help, and risk factors.

What are the symptoms of a decidual cast?

Before your body expels the decidual cast, you may experience bleeding, spotting, and abdominal pain or menstrual cramps, which may be severe.

When it’s expelled, a decidual cast will be red or pink. It will be somewhat triangular and close to the size of your uterus. This is because the entire lining of the uterus exited as one piece. The decidual cast will also appear fleshy because it’s made up of tissue.

It’s possible that the decidual cast will also come out in fragments instead of as a single piece of tissue.

Getting technical

The technical term for the symptoms related to a decidual cast moving from inside your uterus to outside your body is “membranous dysmenorrhea.”

How do the symptoms of a decidual cast differ from those of a miscarriage?

The symptoms of miscarriage and a decidual cast can be similar. Both can lead to cramping, pain, vaginal bleeding, and the loss of large pieces of tissue. Contact a doctor if you think you might be pregnant and experience these symptoms.

What causes a decidual cast?

There’s not a single cause of a decidual cast. You may have this condition for several reasons, including:

Ectopic pregnancy

An ectopic pregnancy is a pregnancy that occurs when an egg is fertilized outside the uterus. This isn’t a viable pregnancy and is considered a medical emergency.

Contact 911 or your local emergency services if you suspect ectopic pregnancy, as it can be life threatening.

Hormonal contraceptives

Hormonal contraceptives, especially those that include a high dose of progesterone, may increase your risk of a decidual cast. These may include oral contraceptives as well as those that can be injected or implanted.

Additionally, you may be at risk of a decidual cast if you’ve recently stopped taking hormonal contraceptives or have been taking them inconsistently.

Other causes for your symptoms

A doctor may consider other conditions with similar symptoms when evaluating your condition, including:

pregnancy
an ended or miscarried pregnancy
intrauterine (within the uterus) masses
fibroepithelial polyps, also known as skin tags
sarcoma botryoides, a type of tumor that develops within hollow organs
rhabdomyosarcoma, a cancer of soft tissue

Decidual cast diagnosis

To determine a decidual cast diagnosis, a doctor will perform a physical examination and discuss your health history. They’ll also ask about any related symptoms you’re experiencing, where you’re feeling them, and for how long you’ve been feeling them.

A pelvic examination isn’t required if you have all the characteristics of a decidual cast. But it may be performed if you don’t see any improvement from medical treatment or if a doctor suspects that you may have secondary dysmenorrhea, or painful periods caused by something other than menstruation itself. An ultrasound may then also be given to differentiate the causes.

If you are at risk for a sexually transmitted infection (STI) or could have a pelvic inflammatory disease (PID), your doctor may need to do a swab.

A doctor may ask whether you might be pregnant or whether you’re taking any hormonal contraceptives.

Before or after you pass a decidual cast, a doctor may conduct some imaging tests. These can help the doctor diagnose the condition. The doctor will also look for other possible conditions, such as ectopic pregnancy or unusual masses in your reproductive system.

You may need to undergo a laparoscopy if all of the noninvasive options still don’t reveal what the cause of your symptoms is.

What increases risk of a decidual cast?

You may be more at risk of developing a decidual cast if you take hormonal contraception. This can include whether you take it regularly or irregularly. You may also be susceptible to a decidual cast if you have just stopped using it as well.

Most people who experience a decidual cast have no health implications following its passage. There’s no reason to think you’ll experience the condition again even if you’ve had a decidual cast before.

Studies have shown that women have no long-term health impacts after passing a decidual cast.

When to get help for a decidual cast

Studies have shown that many people don’t get medical attention for their decidual cast, often due to feelings of embarrassment or their ability to self-manage symptoms. However, you should contact a doctor right away if you experience painful menstrual cramps and vaginal bleeding that differ from what you usually experience during your monthly period.

Also, contact a doctor if you have a prolonged or heavy period or if it’s causing more discomfort than usual. These could be symptoms of a decidual cast or another condition.

Can you prevent a decidual cast?

A decidual cast is rare, and there’s nothing you can do to prevent it.

A decidual cast is a possible side effect of some contraceptives. You should be aware of the side effects of any hormonal contraceptives you use.

Be mindful of any unusual symptoms that may occur when you take contraceptives, such as severe cramps and vaginal bleeding. Some other side effects of hormonal contraceptives can include spotting as well as vomiting and nausea.

What’s the outlook?

Expelling a decidual cast can be very painful and may cause you concern, but ultimately the outlook for people with this condition is good.

It’s rare to experience this condition multiple times, and there are no long-term consequences.

You should contact a doctor if you experience symptoms related to a decidual cast. The doctor will examine you to determine the cause of the symptoms and rule out related conditions. You may need additional testing to diagnose the condition.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Chen CX, et al. (2018). Reasons women do not seek health care for dysmenorrhea.https://pubmed.ncbi.nlm.nih.gov/28681499/
Ekmekci S, et al. (2016). Decidual cast: A case report.https://www.journalagent.com/behcetuz/pdfs/BUCHD_6_3_234_236.pdf
Nagy H, et al. (2021). Dysmenorrhea.https://www.ncbi.nlm.nih.gov/books/NBK560834/
Nunes RD, et al. (2015). Membranous dysmenorrhea — Case report.https://clinmedjournals.org/articles/ogcr/ogcr-2-042.pdf
Period pain: Overview. (2019).https://www.ncbi.nlm.nih.gov/books/NBK279324/
Strauss L. (2018). Fleshy mass passed vaginally by a young woman.https://www.aafp.org/afp/2018/1001/p449.html

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Medically reviewed by Fernando Mariz, MD — Written by Natalie Silver — Updated on May 2, 2022

Decidual Cast: What Is It, Symptoms, And When To Seek Help

What is a decidual cast?

What are the symptoms of a decidual cast?

Getting technical

How do the symptoms of a decidual cast differ from those of a miscarriage?

What causes a decidual cast?

Ectopic pregnancy

Hormonal contraceptives

Other causes for your symptoms

Decidual cast diagnosis

What increases risk of a decidual cast?

When to get help for a decidual cast

Can you prevent a decidual cast?

What’s the outlook?

How we reviewed this article:

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