What causes nosebleeds during menstruation?

Reverse menstruation generally refers to compensatory menstruation. Nosebleeds associated with compensatory menstruation are usually caused by factors such as heightened sensitivity of nasal mucosal epithelial cells to estrogen, endometriosis, or coagulation disorders.

1. Heightened sensitivity of nasal mucosal epithelial cells to estrogen

The nasal mucosa contains a rich network of capillaries. If these capillaries are particularly sensitive to estrogen secreted by the ovaries, they may become congested and swollen, eventually rupturing and causing nosebleeds. Since the ovaries release higher levels of estrogen before menstruation and during the mid-menstrual cycle, this can lead to nosebleeds that occur in a regular pattern, resulting in what is known as compensatory menstruation and manifesting as nosebleeds during menstruation.

2. Endometriosis

This condition may also occur when endometrial tissue implants outside the uterus—such as in the nasal cavity—leading to endometriosis. The ectopic endometrial tissue in these areas responds to estrogen regulation and undergoes cyclical bleeding, which causes recurrent nosebleeds.

3. Coagulation disorders

Congenital or acquired deficiencies in clotting factors can lead to coagulation disorders, impairing blood clotting and increasing the risk of vascular rupture, thereby causing compensatory menstruation and resulting nosebleeds.

In addition, vascular diseases may also predispose individuals to nosebleeds associated with compensatory menstruation.

II. Treatment

1. General management

Apply cold compresses to the nose using cold towels or ice packs to promote vasoconstriction and help stop bleeding.

2. Medication

Under medical supervision, use hemostatic agents such as naphazoline hydrochloride nasal drops, ephedrine nasal drops, or vitamin K1 injection to assist in controlling bleeding.

3. Physical therapy

Under medical guidance, physical treatments such as electrocautery or laser therapy may be used to promote healing of nasal blood vessels and improve symptoms.

The above treatments represent standard approaches. When necessary, additional medications may be required under a physician's recommendation.