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I don’t know about you, but I hear the word “retrograde” and my mind immediately goes to “mercury retrograde” — that cautionary time of the year when astrology believers prep for technology meltdowns and a nonstop string of bad luck.
But fear not, because retrograde menstruation has nothing to do with planetary alignment, and, more importantly, it’s usually not a reason to worry.
“Retrograde menstruation is when blood flows backward (up and out through the fallopian tubes into the pelvis) instead of forward (down through the cervix and vagina),” explains Jessica Ryniec, M.D., a reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston. Now, before you start visualizing backed-up, blood-filled fallopian tubes, take a deep breath, because retrograde menstruation is quite common. “This is actually happening to some degree in most people who have a period (up to 90% in some studies!),” assures Dr. Ryniec.
While retrograde menstruation shouldn’t concern most people, some studies have shown a correlation between retrograde menstruation and endometriosis, which, naturally, may cause some worry. Rescripted spoke with Dr. Ryniec to learn more about retrograde menstruation and its endo connection.
What causes retrograde menstruation?
While Dr. Ryniec says “there is no one clear theory” behind the causes of retrograde menstruation, she does offer one potential explanation: “To expel menstrual blood, the uterus contracts, pushing the blood out. Some people may have dysfunctional uterine contractions that lead to a higher degree of retrograde flow.” She says these dysfunctional uterine contractions could be due to “outflow obstructions like cervical stenosis,” which is a narrowing of the cervix opening, “or congenital uterine anomalies like a unicornuate uterus” (where the patient only has one fallopian tube and a smaller uterine cavity).
What are the symptoms of retrograde menstruation?
“Most people would likely never know or need to do anything about retrograde menstruation,” says Dr. Ryniec. So there’s typically no reason to worry about it. The only way this condition is even diagnosed is if a healthcare provider did “a laparoscopy at time of menses and visualized blood in the pelvic fluid,” she says.
The limited visible symptoms also impact whether or not someone is even aware of their retrograde menstruation: You may not experience any symptoms at all — although Dr. Ryniec does acknowledge that retrograde menstruation “can be associated with painful periods.” Also, keep in mind that even if you have retrograde menstruation, most people will still bleed out of the vagina.
However, there are some retrograde menstruation cases where patients “may not have vaginal bleeding with menses,” says Dr. Ryniec. “This would likely be due to a structural issue such as cervical stenosis.”
Does retrograde menstruation cause endometriosis?
While retrograde menstruation itself isn’t generally a cause for concern in patients, one of the few times it might be is if you have endometriosis.
To be clear, retrograde menstruation does not cause endometriosis, but as previously mentioned, there is a correlation between the two: According to the Cleveland Clinic, it’s possible that, if you have retrograde menstruation, the cells in your uterine lining could get into your fallopian tubes and your pelvis. These cells could then build up on the pelvic organs, causing endometriosis.
But, again, correlation does not equal causation: “[Retrograde menstruation] is one of the theories of how endometriosis develops,” explains Dr. Ryniec, “and it may be one component, but it is not likely the only piece to the puzzle.” This is because retrograde menstruation is more common than endometriosis, “so there has to be something else as well (and there are several theories as to what they could be).”
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Should I even treat retrograde menstruation?
Only if there’s a structural issue — or additional medical diagnoses. “There are treatments for structural causes of retrograde menstruation such as cervical dilation for cervical stenosis or surgical correction of other outflow tract obstructions,” says Dr. Ryniec. In this case of cervical dilation, a physician will widen the cervix with lubricated metal rods (dilators). These particular treatments, Dr. Ryniec says, are “beneficial for treating cyclical pelvic pain and development of endometriosis in people with these structural issues.”
She also lists hormonal suppression of menstruation, as well as the removal of the fallopian tubes or a hysterectomy as potential treatments. Still, she emphasizes that “this would not likely be recommended for the sole purpose of stopping retrograde menstruation.”
The bottom line is that it is highly unlikely you will ever need to worry about retrograde menstruation. If you’re not bleeding at all during your menses, or you’re experiencing symptoms that could point to endometriosis (period and/or sexual pain, infertility, heavy or irregular periods, etc.), then, yes, definitely make an appointment to see your healthcare provider. But otherwise, given how common retrograde menstruation is — and how it’s nearly impossible to know it’s even happening — you can relax the next time your period rolls around.
Mercury retrograde, maybe not so much...
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.