The Surprising Role of the Appendix in Retrograde Menstruation and Endometriosis

Retrograde menstruation is when blood from your period flows backward into your abdomen instead of out your vagina. In a typical menstrual period, your uterine lining (which is a mix of blood and tissue) flows downward and out your vagina. With retrograde menstruation, the blood flows up through your fallopian tubes and into your abdomen. Retrograde menstruation is common and doesn’t typically cause problems.

Retrograde menstruation through the fallopian tubes into the abdominal cavity is a very common event in all menstruating women with open fallopian tubes. Blood can be found in the abdominal fluid in >90% of women with healthy fallopian tubes during time of menstruation.

Retrograde spill is seen in 97% of those with endometriosis. A significant association is found between endometriosis and fallopian tube damage not due to endometriosis. Retrograde menstruation involves the direct-contact deposition of endometrial tissue into the abdominal cavity. Retrograde menstruation leads to endometrial tissue seeding directly onto structures nearby the uterus.

The endometrial tissue can deposit in the fallopian tubes and/or on the appendix and the cecum. This abnormal endometrial tissue can progress to acute appendicitis with chronic inflammation caused by the endometrial glands and stroma, causing the development of fibrous adhesions and enlargement of the appendix and can wholly or partially block the appendices lumen.,

When did @thedrdavefm become aware of Retrograde Menstruation?

A patient with Endometriosis that I had been recommending Progesterone cream as an alternative treatment came to me with a weird story. Yes, I know now that I was just doing what everybody else was doing. She had just returned from Turks and Caicos, where she had participated in a Deep Dive Advanced Scuba Certification. She said she had been at a depth of greater than 130 feet when she experienced severe abdominal cramping and pain. She was taken to a Hospital where she said the Doctors did emergency Paracentesis to remove Sea Water from her abdomen.

She said her local Doctors were shocked and could not explain it. She and I both understood how the Sea water was forced into her body through the vagina, cervix, uterus and fallopian tubes flooding her abdominal compartment. We were stumped as we thought this should have been an impossibility.

If that could happen with sea water, there is no reason it could not happen with blood during menstruation. The Doctors that I attempted to discuss this with dismissed retrograde menses as crazy talk. Obviously, the woman did not know what had happened to her.

Healthcare providers that recognize Retrograde Menstruation understand that many women with retrograde menses are at a higher risk for developing endometriosis. When you have retrograde menstruation, it’s possible that cells from your endometrium (the lining of your uterus) grow in the fallopian tubes or on your abdominal or pelvic organs.

Who is likely to get Retrograde Menstruation?

Retrograde spill is seen in 97% of those with endometriosis. Blood can be found in the abdominal fluid in >90% of women with healthy fallopian tubes during time of menstruation. It’s a normal part of the menstrual process and usually not a cause for worry. It becomes a problem when it leads to painful symptoms or a condition like endometriosis.

Do you bleed with Retrograde Menstruation?

Yes. Women with retrograde menstruation still bleed from their vagina, but some of the bleeding flows in the wrong direction. Instead of coming out your vagina, the blood flows upward through your fallopian tubes and into your abdominal and pelvic cavity. The cells can then grow superficially on the peritoneum (the lining of your abdominal wall that covers your stomach, spleen, intestines and other abdominal organs), or deeper into the abdominal or pelvic organs.

Appendix Cleans Up Retrograde Menses

The Appendix is made up of one way valves. making it a lymphatic sump pump. The learned ones view the appendix as a vestigial mistake, or more recently a bacterial safe house and for far too many a payment for a boat or vacation home.

Think of the appendix as a tethered pool cleaner or Rhoomba; capable of sweeping around the pelvic bowl. Vacuuming fluids (retrograde menses, fluids from intestines), and debris (endometrial clots, bacteria), from the abdominal compartment. 

Much is unrecognized about the function of the appendix. What is known and overlooked by the medical community is that it is composed of lymphoid tissue with valve like structures facilitating one way movement of fluid into the colon. It is located at a lowest point in the abdominal cavity.

The wall of the appendix is composed of all layers typical of the intestine, but it is thickened and contains a concentration of lymphoid tissue. Similar to the tonsils, the lymphatic tissue in the appendix is typically in a constant state of active immune response, and it is generally difficult to tell the difference between pathological disease and the “normal” condition.

Appendicitis in women, may be caused by endometrial tissue blocking the central cavity of the appendix. Young girls with an intact hymen often have their appendix removed due to retrograde menses. 

It is well known that Endometriosis clogging up the appendix can mimic the presentation of acute appendicitis. Symptoms are characterized as nausea, vomiting, abdominal pain which migrates to the right lower quadrant. Physical findings include right lower quadrant tenderness and rebound in the face of a low grade fever., 

Ectopic Pregnancy

Endometriosis-associated peritoneal inflammation also alters tubal physiology and causes a subsequent risk for ectopic pregnancy. This association between endometriosis and ectopic pregnancy is increased especially in women with a previous history of ectopic pregnancy or pelvic inflammatory disease.

Estradiol-17β causes endometriosis to grow. The fertilized egg can implant on endometriosis producing the Estradiol-17β which promotes pregnancy and protects the developing fetus.,  

An Endometrial clot can get lodged anywhere in the fallopian tube. Hematosalpinx is the accumulation of blood in fallopian tubes. Its most common cause is ectopic pregnancy, but the other causes include pelvic inflammatory disease (PID), endometriosis and pelvic trauma.  

Estradiol Promotes Growth of Endometriosis

Endometriosis is an estrogen-dependent disease. Endometriotic tissue produces Estradiol-17β on it’s own. Estradiol-17β which promotes pregnancy and protects the developing fetus., The biologically active estrogen – Estradiol (E2), aggravates the disease processes (e.g., inflammation and growth) and the symptoms (e.g.,pain) associated with endometriosis.  

Endometriotic tissue is deficient in the enzyme that inactivates Estradiol-17β to Estrone (E1) in a healthy uterus lining. This deficiency is another aberration that favors higher levels of Estradiol-17β in endometriotic tissues in comparison with the healthy uterine lining.

What can be done?

There is no way to stop Retrograde Menses since it is a normal occurrence in greater than 90 percent of women. Since the Appendix is responsible for cleaning up Retrograde Menses, looking at factors that influence the function of the appendix would be beneficial.

Portal Hypertension causes the lymphatics to stagnate and flood, creating increased fluid pressure in the pelvic region. This impairs the ability of the lymphoid appendix to absorb the retrograde menses. It does not stop there. Insulin Resistance causes Portal Hypertension. @thedrdavefm looks for the weak links to support and restore normal function.

There are those that will get a Lymphatic massage after reading this. I have one question. Where are they moving the lymph to? The Answer: the abdominal compartment where the Portal Hypertension is causing the portal vein and lymphatics to be stagnant and flooded. One must really understand Insulin Resistance and Portal Hypertension.

You need help and it is not through more hormone testing. @thedrdavefm offers consultations to tailor make a treatment program specific to your needs.