title: Membranous dysmenorrhea: a complication of treatment for endometriosis.
abstract: BACKGROUND
  Progesterones are frequently used to treat endometriosis. Exaggerated response of the endometrium to high levels of progesterone can result in a decidualization reaction. Decidualization may cause an exacerbation of symptoms of dysmenorrhea associated with endometriosis.
  
  
  METHODS
  A 16-year-old girl with uterine didelphys and obstructed hemivagina presented with irregular bleeding and severe abdominal cramping after resection of the vaginal septum. Persistent endometriosis treated with norethindrone acetate resulted in severe colicky abdominal pain and expulsion of a decidual cast.
  
  
  CONCLUSIONS
  Membranous dysmenorrhea can occur in response to excess progesterones. An understanding of the physiologic response of the endometrium to treatment will guide us to a high clinical suspicion of this rare entity when symptoms worsen in response to progesteronal treatment for endometriosis.
authors.affiliation: From the Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, Long Island Jewish Medical Center/Steven and Alexandra Cohen Children's Medical Center of New York, and the Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, New York, New York.
authors.forename: Heather
authors.initials: H
authors.lastname: Appelbaum
mesh_terms: D000293:Adolescent; D004412:Dysmenorrhea / Q000139:chemically induced*; D004717:Endometrium / Q000187:drug effects; D005260:Female; D006801:Humans; D009640:Norethindrone / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077563:Norethindrone Acetate; D011372:Progestins / Q000009:adverse effects*
chemical_list: D011372:Progestins; D000077563:Norethindrone Acetate; D009640:Norethindrone