Catamenial hemoptysis managed with medroxyprogesterone acetate: A management dilemma

Abstract

Introduction: Endometriosis is the deposition of endometrial glands and stroma outside the uterus and can be of pelvic or extra-pelvic type. Thoracic endometriosis syndrome (TES) is associated with endometriosis in the pleura or the lungs, as well as cyclical pneumothorax, chest pain, haemoptysis, and pulmonary nodules. TES can be misdiagnosed for the more prevalent pulmonary tuberculosis in countries such as India. Case Report: A married woman aged 26 years old was presented with complaints of hemoptysis and chest pain during menstruation. On further investigations, she was diagnosed with pulmonary endometriosis after ruling out tuberculosis and Wegener’s granulomatosis. The patient was treated with depot Medroxyprogesterone acetate and regestrone since she was unwilling for surgical management. The significant change in management is that most cases of pulmonary endometriosis have been managed surgically whereas our case has been successfully managed medically. Conclusions: This case is an example for successful medical management of pulmonary endometriosis in patients who cannot or do not want to undergo a bilateral oophorectomy and a possible thoracotomy. Surgical management with bilateral oophorectomy is associated with premature menopausal symptoms, increased risk of cardiovascular diseases, and obesity. In cases of subfertility or in nulliparous women, the medical management of pulmonary endometriosis gives women a chance at fertility in the future.