More Ways to Bleed Than One

Here's an interesting case report of a woman who experiences period-related nosebleeds:

I have a patient with polycystic ovarian syndrome (PCOS) who has had epistaxis but always in the premenstrual phase. She is 45 years of age and has had epistaxis only for 4 years, although she was diagnosed with PCOS at age 16. Local examination was normal. Could menstruation or PCOS or menopause be a reason for epistaxis in this patient?

Three possible explanations for this problem are:

1. Endometriosis. Implants in the nasal lining could be the cause of the cyclic bleeding. [Other distant sites where endometrial implants have been found: lung, skin, and brain.]

2. Bleeding problems. Abnormal bleeding (coagulation problems) could be the result of the cyclical hormonal changes associated with the period.

3. Nasal mucosa abnormalities. The period-related hormone fluctuations could cause changes directly to the nasal lining, making it prone to cyclic bleeding.