Decidual Cast (Womb Tissues)

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Decidua And Decidual Cast

Decidua or decidual tissue is the epithelial lining of the implanted uterus. Because during conception, these epithelial linings get decidualized in the presence of progesterone. Therefore, it is the sloughing off decidua and its per vaginal release out of the body. It frequently shed off in the form of the uterine cavity hence termed decidual cast. (1)

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  • Are Decidual Cast Normal?

     As a healthcare practitioner, I will not consider the decidual cast as a normal condition because severe bleeding and pain can be lethal. The underlying cause can be life-threatening, so it is a female reproductive health issue that should be considered and manage within the limits of time until and unless it becomes a severe health issue. (2)

    Are Sloughing Off Decidua And Membranous Dysmenorrhea Similar Terms?

    There is a difference between these two terminologies as the decidual cast is the sloughed-off decidua (endometrium, which is hormonally capable for conception). Still, membranous dysmenorrhea is a pathological condition that involves sloughing off the complete cast of non-prepared endometrium during menstruation. (3)

    What Causes Decidual Cast To Pass Through Vagina?

    The decidual cast is usually a side effect of oral contraceptives (OC), but several other etiologies that can also result in its genesis are:


    • Ectopic pregnancy
    • Abortion
    • Miscarriage
    • sarcoma (rhabdomyosarcoma and sarcoma botryoides)
    • intrauterine fibroids
    • Intrauterine polyps (4)

    Is Endometrial Sloughing A Miscarriage?

    A decidual cast is not always a sign of miscarriage, but it can mimic a miscarriage. Research evidence has also been reported on the decidual cast in menopausal women, which results in progesterone, human chorion gonadotropin hormone, and human menopausal gonadotrophin hormones. (4)

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  • Does Decidual Cast And Membranous Dysmenorrhea Cause Pain?  

    Decidual cast and membranous dysmenorrhea are severe conditions due to sloughing off endometrial bulk. It’s a passage through the cervix and vagina, but membranous dysmenorrhea might be more painful, and cramping as in this condition cervix remain undissolved. (5)

    There is a direct link between ectopic pregnancy and decidual cast sloughing, as ectopic pregnancy is the commonest cause of endometrial sloughing. (5)

    What Are The Possible Sign And Symptoms?

    The possible sign and symptoms of the decidual cast and membranous dysmenorrhea are: 

    • Abdominal and pelvic muscle cramps
    • Pain
    • Vaginal bleeding and also
    • Excretion of a lump of endometrial tissues

    Therefore, Immediately consult with your healthcare practitioner if you were pregnant or suffering from any other medical condition. Symptoms usually go away once the cast is expelled out from the body. Still, recurrent endometrial cast expulsion in the form of patches and persistent symptoms may assure an underlying pathological condition; that must be dealt with in time. (6)

    How to make Diagnosis?

    The only diagnostic criteria are employing symptoms and the appearance of the cast. Whereas, the cast is usually pink to red in color and triangular in shape, like fallopian funnels at both ends. However, the it always deposes a generous amount of bleeding and abdominal and pelvic pain before its expulsion through the vagina.

    Additionally, some other supportive diagnostic tools are:

    • Diagnostic ultrasound
    • Complete blood count (CBC)
    • Blood CP 
    • Beta HCG blood testing (5) (6)

    When To Seek Medical Help?

    The decidual cast is such a rare condition that Dr. Lee said he had attended only one case is about to 30 years of his overall medical experience. Although it was not a life-threatening condition when you got unbearable pain and mass of tissues in bulk passing through your vagina, so at this moment, you definitely should seek medical advice from your healthcare practitioner. (5)

    How To Manage?

    1. Conservative Management

    Sloughing off endometrium and expulsion of the decidual cast is non-preventable and so could not be stopped; hence, supportive over-the-counter treatment is the only solution.

    Your healthcare practitioner will prescribe you the following medications as per need.

    • NSAIDS
    • Pain killers
    • Progesterone hormone therapy 
    • Further treatment options are based on the underlying cause of endometrial sloughing.

    2. Non-Conservative Management

    The surgical procedure is not recommended until and unless you are menopausal or if it is uterine carcinoma. In such cases, your healthcare practitioner indeed will direct you towards total abdominal hysterectomy (TAH); or bilateral salpingo-oophorectomy (BSO), or vacuum aspiration. (7)

    3. Herbal Treatment

    In the meantime, Chinese herbal medicines are one of the best options for pain management in membranous dysmenorrhea, decidual cast; and also pain of sexual-reproductive origin.

    Evidence-based practice suggests chaste berry, turmeric, Black cohosh, and cramp bark herbs due to their immediate pain-relieving effects. (8)

    Home Remedies To Reduce Pain Of Decidual Cast

    • Application of heating pad
    • Aerobic exercise for 30 min with proper warm-up and cool-down periods
    • Tummy massage with essential oils
    • Yoga/Meditation
    • Warm sits-bath
    • Drink ginger tea
    • Use Pycnogenol plant extract
    • Use turmeric
    • Eat fish oil capsule 
    • Eat foods rich in Vit-B1, Vit-D, mineral calcium also magnesium
    • Sit under the sunlight
    • Stay hydrated and use plenty of dry fruits, especially in winters (9)


    The decidual cast is an unusual and rare health condition that prevails when your hormonal and reproductive systems are not working in a way; that they are generally supposed to be.

    Don’t be afraid and anxious after having such hemorrhagic bleeding. However, consult with your gynecologist for more detailed knowledge about the underlying cause; and also follow up the screening process.

    Therefore, you Don’t need to hesitate to share this with doctor. Besides, Let’s scroll down to the comment section; so feel free and share your concerns and experiences with our experts.

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    1. Yaşar Şen, Emine Ayça Cimbek, Nevzat Serdar Uğraş, Decidual Cast after Discontinuation of Oral Contraceptives Use in a Young Girl, Journal of Pediatric and Adolescent Gynecology, 26(6), 2013, e127-e129.
    2. what is a decidual cast?
    3. Topçu H.O.  Topçu S.  Kokanalı D.  et al.  Spontaneous membranous dysmenorrhea in an adolescent girl: A case report and literature review.  J Pediatr Adolesc Gynecol. 2015; 28: e139-e141.
    4. Stanley W. Wright M.B., B.S.(Lond.), M.R.C.O.G. ENDOMETRIOSIS,BJOG: An International Journal of Obstetrics & Gynaecology,1962, 69(5),711-894. 
    5. How to Stop Heavy Periods: 22 Options for Treatment. 
    6. 25 Ways to Relieve Menstrual Cramps. 
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