The Acute Clinical Features of Retrograde Menstruation

Summary: The acute effects of retrograde menstruation were studied by endoscopy and cytology. The findings suggest that spillage of menstrual blood into the peritoneal cavity is painful. The technique of making this diagnosis is discussed and the therapeutic implications considered. Sampson (1921) suggested that menstrual blood containing fragments of endometrium might pass along the fallopian tubes in a retrograde manner and thus reach the peritoneal cavity. This phenomenon has subsequently been considered to account for the development of endometriosis (Sampson, 1921; Hughesdon, 1972) and possibly even endometrioid carcinoma of the ovary (Feroze, 1976). Any obstruction to the efflux of menstrual blood, including relative cervical stenosis, fibromyomas or congenital defects will favour retrograde menstruation. At the time of menstrual spillage onto the peritoneum does the patient experience pain? Or, is this a ‘clinically silent’ event? What proportion of the normal population have retrograde menstruation, and of those who do, what proportion have clinically detectable signs of blood in the peritoneal cavity? This study was undertaken to answer these clinical questions.