Case Report on Vicarious Menstruation: A Rare Presentation with Multisite Ectopic Bleeding

Vicarious menstruation is a rare clinical phenomenon where cyclical bleeding occurs from extragenital sites in synchrony with the menstrual cycle. It has been reported in fewer than 1% of women with endometriosis and remains largely underdiagnosed due to its atypical presentation. We report the case of a 28-year-old woman with a 10-year history of recurrent monthly bleeding from her nose, ears, and finger pulps coinciding with menses. Conventional evaluations for bleeding disorders were unremarkable, and no obvious lesions were identified on otolaryngologic or dermatologic examination. A clinical diagnosis of vicarious menstruation was made based on the striking cyclical pattern of bleeding. Histopathological analysis of a finger pulp lesion was inconclusive. Ovulation suppression was initiated with a gonadotropin-releasing hormone (GnRH) analogue, resulting in amenorrhea. Concomitant complete cessation of the aberrant bleeding confirmed a therapeutic diagnosis. The patient was subsequently transitioned to oral maintenance therapy with dienogest, a progesterone. The case report highlights the diagnostic challenge of vicarious menstruation. Timely recognition and hormonal management can provide significant relief and prevent ongoing physical and psychological distress in affected patients.