From the Guidelines
Menstruation can be associated with spontaneous pneumothorax in rare cases, particularly in women with catamenial pneumothorax, where air leaks into the chest cavity in relation to menstrual cycles, and treatment should be multidisciplinary, including hormonal treatment or surgery by VATS 1.
Clinical Presentation and Diagnosis
Catamenial pneumothorax typically occurs within 72 hours before or after menstruation, with the associated pneumothorax usually being right-sided, and patients often have a history of pelvic endometriosis 1. The diagnosis should be suspected in female patients who have recurrent pneumothoraces, as it may be relatively underdiagnosed.
Management and Treatment
Management of catamenial pneumothorax should include hormonal treatment or surgery by VATS, with medical therapy to achieve ovarian rest often advocated in the postoperative period 1. For patients with recurrent catamenial pneumothorax, hormonal therapies like oral contraceptives or GnRH agonists might be prescribed to suppress menstruation.
Key Considerations
- The true incidence of catamenial pneumothorax is unknown, but it has been diagnosed in as many as 25% of women undergoing routine surgical treatment for recurrent pneumothorax 1.
- Elective surgery may be considered for patients in whom recurrence prevention is deemed important, such as those who developed a tension pneumothorax at first episode or at-risk professionals 1.
- Discharge and activity advice should be given to all patients post pneumothorax, and conservative management can be considered for minimally symptomatic or asymptomatic primary spontaneous pneumothorax in adults regardless of size 1.
From the Research
Definition and Incidence
- Catamenial pneumothorax is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation 2
- It is also known as menstruation-related spontaneous pneumothorax (MSP) and is associated with diaphragmatic endometriosis 3
- The incidence of catamenial pneumothorax is estimated to be around 3-6% of spontaneous pneumothorax cases among menstruating women, but it may be as high as 25-33% in women of reproductive age 4, 3
Characteristics and Associations
- Catamenial pneumothorax is often right-sided (85-95%) but can be left-sided or bilateral 4
- It is associated with diaphragmatic perforations and/or thoracic endometriosis, and pelvic endometriosis is present in up to 30-51% of cases 4
- The lesions may present as small or larger holes at the central tendon of the diaphragm, or as red, blueberry, brown spots or larger nodules at the diaphragm, visceral or parietal pleura 4
Treatment and Management
- Surgery is the treatment of choice for catamenial pneumothorax, aiming to complete management of all lesions 4
- Hormonal therapy, such as gonadotropin-releasing hormone (GnRH) agonists, may be beneficial in high-risk patients and can help induce amenorrhea 4, 3, 5
- Pleural space management, including mechanical pleurodesis or pleurectomy, may also be performed 5