A Decidual Cast and Endometriosis: Birth of Lasa Health

Ever heard of the gender pain gap?

This is a very real problem where women experience chronic pain at rates 6% higher than men. Feeling like medical providers dismiss your pain — or that pain is just an accepted fact of being female? Yeah, you are so not alone.

Melville knows firsthand that the wait for a chronic pain diagnosis can be interminable: She founded the company after spending a decade trying to find answers for her chronic pain — even enduring a frightening menstrual occurrence called a decidual cast — which ultimately led to an endometriosis diagnosis.

Endometriosis is a condition where tissue similar to the inner lining of the uterus (also called the endometrium) grows outside the uterus. The most common symptom is pain, which can affect the ovaries, fallopian tubes, and the tissue lining the pelvis. But in some cases — including Melville’s — endometriosis growths may be found beyond the pelvic area.

Read on for Melville’s story and how her quest for both a diagnosis and a pain-free existence led her to found Lasa Health.

What is a decidual cast?

“For most of my life, I thought pain was normal,” Melville tells Rescripted. “I popped ibuprofen like candy every month, curled up in bed with a heating pad, waiting for the worst to pass.”

Even though her college roommate had endometriosis, Melville initially refused to believe she and her roommate had the same condition: “I convinced myself my symptoms weren’t as bad as hers, she says. (They were; Melville says she would miss classes due to her symptoms. “I told myself to tough it out, to push through.”

Melville became a regular presence at urgent care, but despite her “excruciating pain,” she only received misdiagnoses (including Pelvic Inflammatory Disease (PID) and treatments that barely alleviated her pain. “I left feeling like a problem no one wanted to solve,” she says.

Melville’s chronic pain took a serious turn when she experienced a decidual cast, something, she tells Rescripted, that “still haunts me.”

A decidual cast is a rare development when your uterine lining sheds in one large piece, instead of in small amounts as it would during a regular menstrual period. Since it emerges in a large tissue form, it can resemble the shape of your uterus. It can also look like a piece of raw red meat because decidual casts consist of tissue, mucus, and blood.

A decidual cast is usually more common in women experiencing an ectopic pregnancy, but it can also manifest as a result of using progesterone contraceptives.

Melville explains that her decidual cast did indeed occur after she started birth control, and that it was “about the size of my hand.” While decidual casts don’t usually cause any long-term complications, the pain levels can be agonizing: “I thought I was going to die,” Melville tells Rescripted. “I couldn’t move. I couldn’t speak. I couldn't even ask for help.”

But when she contacted her physician, she was summarily dismissed: “I called my doctor in a panic,” says Melville. “Their response? It was probably a miscarriage. No need for a follow-up appointment.”

According to the Cleveland Clinic, a decidual cast is not a miscarriage. It’s also important to mention that there isn’t a direct link between decidual casts and endometriosis, though some people with endometriosis do experience decidual casts. But for Melville, her doctor’s apathy left her believing that her pain didn’t matter: “That single moment shaped how I saw my pain. If this wasn’t worth a doctor’s visit, then what was?

“So I stopped asking for help.”

Launching Lasa Health

Several years after the decidual cast incident, Melville had built a successful career in health innovation and was completing her MBA. But she continued to be “frustrated by the standard of care for women and the diagnostic delays that women face.” This galvanized her to start a business called Lasa Health. Its mission is “to improve the diagnosis of women's health conditions using AI and machine learning.”

As part of her new project, Melville decided to interview 100 women with endometriosis: “Nearly all of these women had been dismissed, misdiagnosed, or forced to fight for care,” she tells Rescripted. “Many of them had spent years — sometimes decades — searching for a diagnosis.”

Melville realized that she shared many of the symptoms with these women sharing their stories: “I became convinced that I had endometriosis, too.”

Unfortunately, she would hit several more roadblocks toward diagnosis, in the form of her own doctors.

“One said, ‘Oh, your periods aren’t bad enough for that.’

Another? ‘You’re too fat to have endometriosis — it’s probably diabetes.’”

Finally, an endometriosis diagnosis!

Eventually, about a year later, Melville found a specialist who not only suspected she had endometriosis but “recommended a diagnostic laparoscopy and excision surgery.” Now, the hard part for Melville was convincing herself that she was finally getting the help she so desperately needed: “After so many years of dismissing myself — and being dismissed by doctors — I struggled to believe it.”

So much so that she almost canceled the surgery multiple times.

“I was terrified I’d wake up to nothing,” Melville tells Rescripted. “No diagnosis, no answers — just another doctor telling me it was all in my head.” But it wasn’t “nothing,” or all in her head. During the surgery, Melville’s doctors found deep infiltrating endometriosis on her rectum and sigmoid colon, as well as superficial peritoneal disease. “I felt so validated to finally have an answer and [to feel] hopeful for the first time in years!” says Melville.

Endometriosis surgery: Only one piece of the puzzle

While it was a relief to have a diagnosis, Melville quickly learned that living with endometriosis is complicated: “A few months after my surgery,” she says, “I went to an endometriosis support group. Most of these women had gone to the same surgeon as me, but every single one of them was still suffering.

“That’s when I realized that surgery is not a cure,” she continues. “It’s a piece of the puzzle, but endometriosis care requires a multidisciplinary approach — something our healthcare system isn’t built for.” Since then, Melville has devoted much of her time to understanding endometriosis, trying alternative therapies like pelvic floor therapy, trigger point injections, and different medications. She also “dove into the medical literature,” soon understanding that “the more I learned, the more I saw just how fragmented and inadequate our care really is.”

Melville’s final message to Rescripted readers? That they are not alone. “Your pain is real,” she emphasizes. “You deserve to be heard. And together, we can make sure the next generation doesn’t have to fight this hard for care.”

Learn more about the Lasa Health mobile app here. If you think you might have endometriosis, you can check your symptoms for free here.