Catamenial Pneumothorax

Catamenial pneumothorax (cat-uh-MEE-nee-uhl new-mo-THOR-axe) is when you get air in the space between your lungs and the inside of your chest around the time of your period. “Catamenial” means related to menstruation (your period) and “pneumothorax” means air in your chest cavity. The air can surround and squish your lung and sometimes collapse part or all of it. In most people, it affects their right lungs.

The relationship between your menstrual cycle and pneumothorax might seem mysterious. And the cause isn’t always clear to healthcare providers, either. Causes range from conditions like endometriosis to period-related hormone changes.

But the important thing to know is that you should always see a provider about chest pain and shortness of breath. While most cases of aren’t life-threatening, pneumothorax can sometimes be dangerous — and its symptoms are similar to other serious health conditions.

What are the symptoms of catamenial pneumothorax?

Symptoms of catamenial pneumothorax include:

• Chest pain
• Difficulty breathing
• Cough
• Coughing up blood (hemoptysis)
• Fast breathing or heart rate
• Bluish skin, lips or nails (cyanosis)

Symptoms usually start within a few days before or after the start of your period.

What causes catamenial pneumothorax?

Healthcare providers think endometriosis — when tissue similar to the lining of your uterus (endometrium) grows somewhere else in your body — is the main cause of catamenial pneumothorax. If you have endometrium in your lungs, pleurae (linings of your lungs and chest wall) or diaphragm, it could cause air to enter the space between the linings of your lungs (pleural space). This could lead to pneumothorax. Catamenial pneumothorax is also called endometrial pneumothorax when you know that endometriosis caused it.

But not everyone with catamenial pneumothorax has endometriosis. Hormones and inflammation can cause changes in your body that affect your lungs during your period. Possible factors that can play a role in developing pneumothorax during menstruation include:

• Prostaglandins causing reduced blood flow. These hormone-like chemicals can lead to air pockets in your lungs rupturing and the air escaping into the pleural space.
• Air moving through your reproductive tract. It can get through small holes in your diaphragm and into your pleural space.

What happens when endometriosis spreads to your lungs?

Endometriosis in your lungs or the structures around them can cause thoracic endometriosis syndrome. In addition to pneumothorax, this can lead to:

• Blood in your pleural space (hemothorax)
• Pulmonary (lung) nodules
• Coughing up blood around the time of your period (catamenial hemoptysis)

Pneumothorax that happens between periods can still result from endometrium growing in or around your lungs or diaphragm, even if you don’t have an endometriosis diagnosis.

What are the risk factors for catamenial pneumothorax?

Catamenial pneumothorax is most common in females who ovulate. Rarely, those on hormonal birth control or who are pregnant experience it. You might be at higher risk if you or someone in your family has endometriosis.

What are the complications of catamenial pneumothorax?

In some cases, pneumothorax can lead to serious complications, like respiratory failure or heart failure. This is uncommon, but you should always have a healthcare provider evaluate you if you have symptoms of pneumothorax — especially since the symptoms can be similar to other serious health conditions.

How is catamenial pneumothorax diagnosed?

Providers usually diagnose catamenial pneumothorax by listening to your lungs and looking at them with imaging. Imaging might include chest X-rays, CT scans or a lung ultrasound.

To help your provider determine a cause, it might be helpful to tell them if:

• You’re expecting to get your period soon
• You’ve recently started your period
• You’ve experienced these symptoms around the time of your period before

Your provider may not be able to diagnose the exact cause of pneumothorax without surgery or a biopsy.

How is catamenial pneumothorax treated?

Pneumothorax usually gets better on its own. But you might need thoracentesis or a chest tube to reduce the air in your chest.

To prevent it from happening again, your provider might recommend:

• Video-assisted thoracoscopy (VATS). During this surgery, your provider can remove endometrial tissue, fix issues with your diaphragm or close air pockets (blebs).
• Medications. Your provider might prescribe medications that regulate your hormones, like oral contraceptives, gonadotropin-releasing hormone agonists or danazol.
• Pleurodesis. During surgery, your provider can attach your lung to your chest wall using chemicals or by gently scraping your pleura.
• Hysterectomy with bilateral oophorectomy. If other treatments don’t work, surgery to remove your uterus and ovaries will stop you from ovulating.

When should I see my healthcare provider?

Talk to your healthcare provider if you have concerning symptoms that happen around your period. Always see a provider if you’re having chest pains or trouble breathing.

It might be helpful to ask your provider:

• Do you know what caused this?
• What are my treatment options?
• If I need to have a chest tube, how long will I have it?
• Will I need to stay in the hospital?
• How do I take care of myself at home?
• How do I take this medication?

When should I go to the ER?

Go to the emergency room if you have symptoms of pneumothorax, like chest pain or difficulty breathing. These can be signs of many serious health conditions. You may need emergency treatment.

Can catamenial pneumothorax be prevented?

Catamenial pneumothorax usually comes back many times. Depending on the cause, surgery, hormone-regulating medications or both can prevent it from happening again.

What can I expect if I have catamenial pneumothorax?

Catamenial pneumothorax is usually not life-threatening. But if you’ve had it happen once, it will often keep coming back without treatment. You may need multiple types of treatment (like surgery and medications) to manage it.