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A CONSULTANT obstetrician, gynaecologist and reproductive medicine specialist at Prince Court Medical Centre, Dr Maiza Tusimin, said the condition occurs when endometrial tissue, which normally lines the uterus, grows in the chest cavity or lungs and bleeds in sync with menstruation.
She warned that the condition requires accurate diagnosis and timely treatment to prevent serious complications, including permanent lung damage due to fibrosis, infection such as empyema, and anaemia caused by repeated blood loss.
Recalling a case during her tenure at Hospital Serdang about a decade ago, Dr Maiza said she treated a patient who presented with shortness of breath and recurrent haemoptysis.
“What drew attention was that the symptoms only occurred each time the patient menstruated. The pattern of symptoms recurring in line with the menstrual cycle raised suspicion of thoracic endometriosis syndrome,” Bernama reported her saying.
The patient was subsequently referred to a respiratory specialist and the diagnosis was confirmed through a tissue biopsy conducted during a video-assisted thoracoscopic surgery procedure.
“The biopsy results showed the presence of endometriosis tissue in the airway. This proves that endometriosis does not only occur in the pelvic region, but can also affect other areas including the lungs,” she said.
According to the Health Ministry, endometriosis occurs when endometrial tissue grows outside the uterus, such as in the ovaries or pelvic lining, and continues to respond to hormonal changes, often leading to chronic conditions including severe menstrual pain.
Dr Maiza said several medical theories explain how the tissue can reach the chest, including retrograde menstruation, where endometrial cells flow backwards through the fallopian tubes into the abdominal cavity before entering the chest through defects in the diaphragm.
She added that the cells may also spread via blood vessels or the lymphatic system, or develop through cellular transformation in the lung lining influenced by hormones.
“When endometriosis tissue is present in the chest cavity, it still responds to hormonal changes as if it were in the uterus,” she said.
“This can cause patients to experience coughing up blood if it involves the airway, or a collapsed lung if it affects the pleural lining,” she added, noting that symptoms typically appear within 24 to 48 hours before menstruation or within two to three days after it begins.
In terms of treatment, Dr Maiza said initial management usually involves hormone therapy, including combined oral contraceptives, progestin injections or GnRH-based treatments.
“Procedures typically involve video-assisted thoracoscopic surgery to remove endometriosis tissue and repair diaphragm defects. The best approach based on studies is a combination of surgery and hormonal treatment to reduce the risk of recurrence,” she said.
Meanwhile, a patient, Aisah Saleh, 38, said years of unexplained suffering since her teenage years were only resolved in January 2021 when she was diagnosed with catamenial pneumothorax.
The mother of three said she had long experienced recurring chest pain, breathing difficulties and discomfort on the right side of her chest during menstruation, sometimes to the point of nearly fainting.
“I relied on painkillers and rest to ease the pain. The condition worsened over time before X-rays and CT scans revealed the real cause.
“Doctors explained that the condition, such as a collapsed lung, could be fatal if oxygen supply to vital organs is compromised,” she said, adding that she underwent surgery in September last year.
She said the condition had significantly affected her quality of life and career, as recurring monthly pain limited her physical activity. - March 23, 2026