title: Passage of decidual cast following poor compliance with oral contraceptive pill.
abstract: BACKGROUND
  Decidual cast describes the spontaneous sloughing of endometrium as an entire piece while retaining the shape of the endometrial cavity. It may be associated with increased serum progesterone levels and must be considered as a differential diagnosis in a patient who passes tissue per vagina while on progesterone containing hormonal contraception.
  
  
  METHODS
  A 13-year-old adolescent with a history of menorrhagia since menarche, presented to the pediatric emergency room with worsening abdominal pain and heavy vaginal bleeding stopping her oral contraceptive pill 10 days prior to presentation. Her symptoms resolved spontaneously following passage of tissue per vagina which was later by histopathology to be a decidual cast.
  
  
  CONCLUSIONS
  Decidual cast is a rare pathological entity that may be a side effect of progesterone-containing hormonal contraceptives, requiring patient education before use.
authors.affiliation: 1Department of Obstetrics and Gynecology, Hutzel Womens Hospital, Wayne State University School of Medicine , Detroit, MI , USA.
authors.forename: Mokerrum F
authors.initials: MF
authors.lastname: Malik
authors.forename: Henry
authors.initials: H
authors.lastname: Adekola
authors.forename: William
authors.initials: W
authors.lastname: Porter
authors.forename: Janet M
authors.initials: JM
authors.lastname: Poulik
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy* / Q000473:pathology; D011374:Progesterone / Q000627:therapeutic use*; D016896:Treatment Outcome; D014599:Uterus / Q000187:drug effects / Q000473:pathology*
chemical_list: D003277:Contraceptives, Oral, Combined; D011374:Progesterone
keywords: adolescent; menorrhagia; progesterone-containing hormonal contraception