Retrograde menstruation in women undergoing chronic peritoneal dialysis

Blood in the peritoneal dialysis catheter just before menstruation was regularly observed in 9 of 11 premenopausal women maintained on peritoneal dialysis for end-stage renal failure. Peritoneal bleeding at other times during the menstrual cycle was not seen in any of these patients. Likewise, peritoneal bleeding in men or nonmenstruating women on chronic peritoneal dialysis was exceedingly rare, was not periodic, and usually was due to recognizable causes. These observations suggest that retrograde menstrual bleeding into the peritoneal cavity is the rule rather than the exception in women on peritoneal dialysis and possibly in all menstruating women. Implications of this observation for the pathogenesis of endometriosis and dysmenorrhea are discussed.