Recently, 24-year-old labor and delivery nurse Madi Swegle (@sweglestory) posted a TikTok about what happened when she basically passed her entire period at once, and, honestly, it sounds like a really frightening experience.
In a video that has been viewed over six million times, Madi shared her story. She says, "So something extremely scary and honestly a little traumatic happened to me last night... This is important. I've never heard of this before in my life. I'm a nurse. Never heard of it. I wish I had, which is why I'm posting this video."
She says her period started as normal, but then took a sharp turn. "Basically, yesterday, my cycle started. It started out as a normal cycle, normal cramping, normal flow. Everything was very normal. Around 7 p.m. last night, my cramps suddenly got very, very intense."
"This pain is the worst pain I've honestly felt my entire life. I was on the toilet for about an hour. I had a heating pad. I had a bucket in front of me because I felt nauseous from the pain. I had goosebumps all over, and it wasn't like normal cramps where they kind of like ebb and flow. It was a consistent severe pain."
And sadly, because we are so socialized to think of even severe menstrual pain as "normal," Madi says she kind of doubted herself. "The amount of pain I was in, Jake [her husband] was like, 'Do we need to take you to the ER? This is not normal.' And I was like, 'No,' I thought it was just an awful period. And honestly, I thought I was just being a big baby about the pain."
Then, Madi says something really strange happened. "An hour later, after this consistent, like, never-ending extremely painful cramp, something came out of me. At first, I thought it was a massive blood clot. But it wasn't. It was tissue about the size of my palm and it was in the perfect shape of my uterus. The best way I can think to describe it is if you've ever seen or felt a placenta, it felt like that kind of tissue."
"After it passed though, my cramps completely went away and I felt 100 times better. I immediately texted my OB a picture of it, because what the heck is this thing, and I ran to Google. It turns out it is something called a decidual cast. So instead of shedding your uterine lining over a series of days during your period, it's when your entire uterine lining comes out in one piece through your cervix. Apparently it's extremely rare, but it happened to me, and the cramps I was feeling were really like contractions, and my cervix dilated a little bit to pass this."
In the comments, some people were stunned to learn that this is even a thing, while others commented in solidarity to share that they've also experienced a decidual cast.
And some commenters shared that they've experienced this multiple times or had a decidual cast come out in multiple pieces.
To learn more, I reached out to board-certified OB/GYN Dr. Erica Montes. During a normal period, your uterine lining sheds and flows out piece by piece. But Dr. Montes explained that in the case of a decidual cast, this lining comes out in one piece, molded in the shape of the uterus.
"A decidual cast is an intact piece of tissue that is made up of your uterine lining, or endometrium. It happens when the part of your lining called the decidua sheds all at once and can create an exact shape of your uterine cavity or a triangular 'cast.'"
Dr. Montes says that this condition is thought to be extremely rare, but it may be linked to ectopic pregnancy. "There have been some studies that say it could be a sign of an ectopic pregnancy. If you have a positive pregnancy test and pass a cast, it is important to take the tissue to your physician so it can be sent to pathology for evaluation."
But people who are not pregnant have also reported passing a decidual cast, and some of these instances have been linked to hormonal birth control. If you experience something unusual like a decidual cast, it's a good idea to get checked out by a doctor so you know for sure what's going on.
If you think you're passing a decidual cast, reach out to your OB for guidance. Dr. Montes says you should also be sure to treat the pain. "In that moment, it is best to take an anti-inflammatory or an over-the-counter pain medication that usually helps with your menstrual cramps. While this pain can be definitely more than usual cramps, once you pass the cast, it should subside fairly quickly. Follow-up care should be made if you also have a positive pregnancy test, if your bleeding is more than one pad an hour, or if your pain doesn't improve."
I also reached out to Madi, who says this was a really scary experience for her, but it would've been so much easier if she'd known what the heck was going on. "I was so terrified when it happened, and I had no clue what had just come out of my body. I FaceTimed some other nurses I work with to show them what happened and see what they thought. No one knew what it was until my OB explained everything to me."
"The fact that I am a nurse in obstetrics and my coworkers and I have never heard of this made me want to share my story with others even more. I think if I had known what a decidual cast was before I went through it, I would have been a lot less anxious when it happened to me. I hope that by being open about this, other women can be prepared and have some understanding of decidual casts if this ever happens to them."
And she says she is blown away by the response to her video. "The comments are filled with women who have experienced this and never knew what it was — or women who experienced this and thought they had a pregnancy loss. I’m so glad that others are finding my story helpful and I hope that by raising awareness, more women are knowledgeable and prepared in case this ever happens to them."
Finally, she hopes her story will encourage others to listen to their bodies. "Listen to your body and don’t be afraid to ask your doctor questions. I think women often downplay their pain because they are afraid of being seen as 'weak' or 'dramatic.' I know that when I was experiencing the pain related to passing my cast, I told myself that I was overreacting. This whole experience has really validated how necessary it is to listen to your body and get checked out if something feels off."