Menstruation From The Umbilicus: An Unusual Case Report

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Menstruation
Source: Freepik

A parous woman, aged 35, presented with a complaint of regular bleeding from her umbilicus. According to her, this bleeding occurred in harmony with her normal menstruation, starting two days before menses and lasting its entire duration. This was her fourth month experiencing the same sequence. Not to mention, it caused swelling and pain in the umbilicus too.

The woman further told about her two vaginal deliveries without any significant complications. Also, she did not report having any abdominal surgeries or hormonal contraception.

Clinical Examination for Such Unusual Menstruation

Clinical examination surfaced a 2cm by 2cm nodule wrapped up in a reddish-brown discharge. Suspecting an infection, the doctors covered it with a swab and started the woman’s treatment with a course of oral antibiotics. To their disappointment, it did no good as the woman returned after two months without any visible improvement in her symptoms.

Next, they subjected the patient to an abdominal ultrasound. It revealed a 15mm thin-walled cyst just below the skin in the umbilical region. Good thing, now they knew it wasn’t just some random bacterial infection. Furthermore after scratching their heads over the condition’s temporal association with menstruation, they concluded they were dealing with an umbilical endometriosis.

The Next Step?

With both medical and surgical treatments on the table, the patient opted for a medical management first. Thus she received Zoladex injections (AstraZeneca UK, Goserelin acetate, 3.6 mg subcutaneously, monthly) for three months. Bad thing, it failed to roll in a decrease in umbilical swelling. Now the patient asked for a surgical excision. And rightly so, she got her nodule resected along with umbilical reconstruction.

Post-operative histology of the nodule confirmed the presence of endometrial glands with mucinous type hyperplasia. Nevertheless, the patient was re-assessed six weeks after her surgery and to everybody’s delight, she came out to be completely asymptomatic. Just that the doctors told her it might recur. A joy-killer right?

2 COMMENTS

    • Yes,the rate of recurrence is high after a conservative surgery. The treatment options remain using hormonal contraceptives, GnRH (gonadotropin releasing hormone) agonists and antagonists and IUDs like Mirena that slowly release progesterone. The goal is to avoid over-stimulation of endometrial tissue and consequent shed and menstruation. But of course you have to keep factors such as the woman’s age and fertility in mind before coming to a conclusion, too.

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