Catamenial dyspnea due to intraparenchymal pulmonary endometriosis

Specialty: Respiratory.

• menstrual dyspnea due to pulmonary endometrial foci
• Parenchymatous catamenial dyspnea

Why it occurs

• Intraparenchymal pulmonary endometriosis (presence of functional ectopic endometrial tissue located directly in the lung parenchyma that responds to the hormonal stimuli of the menstrual cycle, bleeding cyclically and causing localized alveolar inflammation, edema and microatelectasis, clinically manifested by dyspnea and hemoptoic sputum coinciding with the beginning of menstruation)
• Localized catamenial pneumonitis secondary to recurrent alveolar bleeding.

Initial workup

High-resolution computed tomography (CT) of the chest taken during menstruation (showing ground-glass opacities or small nodules that disappear or decrease drastically in the follicular phase of the cycle); Magnetic resonance imaging (MRI) of the chest; Flexible bronchoscopy with bronchoalveolar lavage during bleeding to look for macrophages with hemosiderin; Determination of serum CA-125 levels.

Standard management

• Goserelin — GnRH analogue, 3.6 mg subcutaneously every 28 days to suppress ovarian function and promote atrophy of pulmonary endometrial tissue
• Leuprolide — 3.75 mg intramuscularly every 28 days
• Tranexamic acid (500-1000 mg orally every 8 hours during the days of menstrual bleeding to reduce the magnitude of hemoptysis).