This Nurse’s TikTok About Passing a Decidual Cast During Her Period Is Harrowing
As anyone who menstruates knows, getting your period isn’t always fun. At 28, having had plenty of experience with cramps, mood swings, and bloating, I thought I’d learned about most of the unpleasant things that can happen to the body during the menstrual cycle—but a TikTok recently taught me about one I’d never heard of before.In the viral video, Madi Swegle, an Iowa-based nurse, described a recent period that started off normal, but quickly turned nightmarish. “My cramps suddenly got very, very intense,” Swegle, who did not respond to a request for comment made via Instagram, said. She added that she made her way to the toilet out of instinct. “I had a heating pad; I had a bucket in front of me because I felt nauseous from the pain. It was a consistent, severe cramp.” The pain was so bad, Swegle said in the video, that she and her partner talked about going to the emergency room. “I thought it was just an awful period,” Swegle explained. “Then, an hour later, after this consistent, never-ending, extremely painful cramp, something came out of me.”Swegle said she passed something that was roughly the size of her palm and shaped like her uterus—which prompted her to take a picture of what she was looking at in the toilet and send it to her ob-gyn. “It was terrifying to see it come out of my body… because what the heck is this thing?” Swegle said. As it turns out, she said, it was a decidual cast, which is medically known as a membranous dysmenorrhoea, Alyssa Dweck, MD, FACOG, a New York-based gynecologist, tells SELF.A decidual cast develops when, instead of gradually shedding tissue, blood, and mucus as you would during a typical period, your body ejects the entire membrane lining of your uterine cavity—called the endometrium—in one fell swoop, Dr. Dweck says. “Possibly, it has something to do with mucus formation, but nobody seems to understand why this happens,” though people who use hormonal birth control methods may be slightly more likely to pass a decidual cast, she says.The pain Swegle was talking about can be extreme, Dr. Dweck adds: “The cervix will dilate a little bit,” she explains, “and because you have to pass this through a very small opening, it’s going to cause quite a bit of pain.” As Swegle noted in her experience, it’s going to look similar to a uterus. “It looks like a triangle, because that’s the shape of the uterine cavity,” Dr. Dweck says. Swegle’s first thought was that she’d passed a large blood clot, but Dr. Dweck says decidual casts won’t be as flimsy as clots. “Tissue, if you hold it in your hand, is spongy and looks like liver or meat. It wouldn’t just tear apart easily, while a blood clot would disintegrate a little bit easier,” she explains.The good news is, you don’t typically need treatment if this happens to you—once the decidual cast passes through, relief will set in. “People miraculously just feel so much better,” Dr. Dweck says, adding that the pain and cramping should subside quickly.