Catamenial pneumothorax is a rare condition where the pleural tissue surrounding the lung ruptures due to endometriosis, causing the lung to collapse. Surgery is needed to repair the lung, and medication and hormonal supplements may be given to prevent recurring episodes. Emergency care is needed to identify and treat a collapsed lung, and medical therapy may be given to prevent future episodes.
Catamenial pneumothorax is a rare condition that can affect women just before or during their menstrual cycle. The pleural tissue surrounding one of the lungs ruptures, leading to pressure buildup in the chest which eventually causes the lung to collapse. Most specialists believe that catamenial pneumothorax is the result of endometriosis, a condition in which the cells of the pleural lining react to menstruation in a similar way to uterine cells: rupture and bleed during a period. Surgery is usually needed to repair a collapsed lung, and the patient may be given medications and hormonal supplements to help prevent recurring episodes.
Endometriosis in areas near the uterus is a fairly common condition, with uterus-like cells usually emerging in the long intestine, ovaries, or bladder. It is extremely rare for such cells to appear elsewhere, especially in the lungs. Doctors don’t fully understand how or why abnormal cells emerge. When they are present in the lungs and triggered by menstruation, they can form cysts that swell and bleed. Inflamed cysts can open and leak air from the lung into the pleural lining and chest cavity. Within about 72 hours of a rupture, the lung is likely to collapse.
Catamenial pneumothorax can potentially affect any woman of reproductive age who has not yet reached menopause. It is most common in individuals between the ages of 30 and 40. It is likely that a woman suffering from catamenial pneumothorax will first notice shortness of breath that gets worse over time. You may have severe chest pains, fast heartbeat and low blood pressure, symptoms that cause fatigue and dizziness. Without prompt treatment, you may lose consciousness or stop breathing altogether.
Emergency care is needed to identify and treat a collapsed lung. If the patient is stable, doctors may take chest X-rays and blood tests to determine the location of the cysts and confirm that air has indeed escaped from the lung. A tissue biopsy and hormone tests may be done to determine whether or not your symptoms are related to endometriosis.
A woman who is brought to the emergency room in critical condition typically needs immediate surgery to preserve breathing. A chest tube is inserted to remove excess blood and air. Once the space is cleared, the damaged lung tissue can be repaired with surgical staples and glues. Surrounding tissue that hasn’t broken yet but looks suspicious is excised.
After emergency treatment, doctors may start a course of medical therapy to prevent the catamenial pneumothorax from recurring. Many women are asked to take oral contraceptives daily to suppress menstruation. Hormone therapy, which involves medications or injections, may be given to reduce the risk of endometriosis. Most women who experience catamenial pneumothorax are able to prevent future episodes by taking medications and scheduling regular checkups with their doctors.
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