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Vaginal bleeding
ICD-10 N92-N93, N93.8
MedlinePlus 007496

Vaginal bleeding is any bleeding through the vagina, including bleeding from the vaginal wall itself, as well as (and more commonly) bleeding from another location of the female reproductive system. Generally, it is either a physiologic response during the non-conceptional menstrual cycle or caused by hormonal or organic problems of the reproductive system. Vaginal bleeding may occur at any age, but always needs investigation when encountered in female children or postmenopausal women. Vaginal bleeding during pregnancy may indicate a possible pregnancy complication that needs to be medically addressed.

Blood loss per vaginam (Latin: through the vagina) (PV) typically arises from the lining of the uterus (endometrium), but may arise from uterine or cervical lesions, the vagina, and rarely from the Fallopian tube. During pregnancy it is usually but not always related to the pregnancy itself. Rarely, the blood may actually arise from the urinary tract (hematuria), although the vast majority of women can identify the difference. It can also be a sign of vaginal cancer.

Differential diagnosis[edit]

Bleeding in children[edit]

Bleeding before the expected time of menarche could be a sign of precocious puberty. Other possible causes include the presence of a foreign body in the vagina, molestation, vaginal infection (vaginitis), and rarely, a tumor.

Premenopausal women[edit]

Pregnant women[edit]

Vaginal bleeding occurs during 15-25% of first trimester pregnancies.[2] Of these, half go on to miscarry and half bring the fetus to term.[2] There are a number of causes including rupture of a small vein on the outer rim of the placenta. It can also herald a miscarriage or ectopic pregnancy, which is why urgent ultrasound is required to separate the two causes. Bleeding in early pregnancy may be a sign of a threatened or incomplete miscarriage.

In the second or third trimester a placenta previa (a placenta partially or completely overlying the cervix) may bleed quite severely. Placental abruption is often associated with uterine bleeding as well as uterine pain.

Postmenopausal women[edit]

All vaginal bleeding in postmenopausal women should be medically assessed. The differential diagnosis is:[citation needed]

  • 30% unopposed estrogen
  • 30% atrophic endometritis / vaginitis
  • 15% endometrial cancer
  • 10% endometrial polyps or cervical polyps
  • 5% endometrial hyperplasia
  • 10% other

Diagnostic approach[edit]

The diagnosis can often be made on the basis of the bleeding history, physical examination, and other medical tests as appropriate. Typically a pregnancy test and additional hormonal tests, a Pap smear, a transvaginal ultrasound are needed. If bleeding was excessive or prolonged, a CBC may be useful to check for anemia. Abnormal endometrium may have to be investigated by a hysteroscopy with a biopsy or a dilation and curettage.

The treatment will be directed at the cause. Hormonal bleeding problems during the reproductive years, if bothersome to the woman, are frequently managed by use of combined oral contraceptive pills.

Complications[edit]

Severe acute bleeding, such as caused by ectopic pregnancy and post-partum hemorrhage, leads to hypovolemia (the depletion of blood from the circulation), progressing to shock. This is a medical emergency and requires hospital attendance and intravenous fluids, usually followed by blood transfusion. Once the circulating volume has been restored, investigations are performed to identify the source of bleeding and address it. Uncontrolled life-threatening bleeding may require Uterine artery embolization (occlusion of the blood vessels supplying the uterus), laparotomy (surgical opening of the abdomen), occasionally leading to hysterectomy (removal of the uterus) as a last resort.

A possible complication from protracted vaginal blood loss is iron deficiency anemia, which can develop insidiously. Eliminating the cause will resolve the anemia, although some women require iron supplements or blood transfusions to improve the anemia.

References[edit]

  1. ^ Farlex Medical Dictionary > Withdrawal Bleeding, in turn citing Mosby's Medical Dictionary, 8th edition
  2. ^ a b Snell, BJ (Nov–Dec 2009). "Assessment and management of bleeding in the first trimester of pregnancy.". Journal of midwifery & women's health 54 (6): 483–91. doi:10.1016/j.jmwh.2009.08.007. PMID 19879521. 

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125 news items

India.Com Health

India.Com Health
Wed, 16 Apr 2014 21:55:44 -0700

pregnant woman woes During your last trimester if you notice spotting or vaginal bleeding get up and rush to the hospital. This isn't the time to ponder on the causes and consequences of spotting. Bleeding at this stage usually indicates danger or an ...

India.Com Health

India.Com Health
Wed, 23 Apr 2014 03:30:00 -0700

Irregular or heavy vaginal bleeding: There is no particular pattern of bleeding during the pre-menopausal phase. You may either experience heavy or frequent vaginal bleeding or have your periods placed far apart. This can continue for few years before ...
 
Albany Times Union (blog)
Tue, 22 Apr 2014 12:36:00 -0700

Vaginal bleeding is another common sign of abruption, though the degree of hemorrhage is case dependent. If an abruption is severe (i.e. the entire placenta separates from the uterine wall, rather than just a portion) than the uterus may contract ...
 
Frederick News Post (subscription)
Tue, 22 Apr 2014 23:00:00 -0700

American ginseng also has side effects, including rapid heartbeat, vaginal bleeding, liver damage, birth defects and uterine cancer. With all teas, herbal or true teas and coffee as well it's important to realize some resulting negative conditions ...

Medical Daily

Medical Daily
Tue, 22 Apr 2014 05:00:00 -0700

However, women who do not take birth control and still see bleeding after their period should consult their doctor. Medline Plus suggests that vaginal bleeding could be due to cancer or precancer and should therefore be evaluated immediately. In other ...

India.Com Health

India.Com Health
Tue, 22 Apr 2014 03:05:56 -0700

Spotting: Some amount of vaginal bleeding during the early days of pregnancy is normal. This happens when the fertilized egg instils itself on the wall of the uterus. This kind of discharge is different from your normal periods. It is light and would ...
 
SouthCoastToday.com
Wed, 02 Apr 2014 21:31:53 -0700

Women using vaginal estrogen therapy should be instructed to report any unusual vaginal bleeding, which should be evaluated by her gynecologist. Progestins typically do not need to be prescribed to women using only low-dose vaginal estrogen products ...

SpaceCoastDaily.com

SpaceCoastDaily.com
Wed, 09 Apr 2014 15:07:30 -0700

Nyberg's urogynecological odyssey began in 2008 with copious vaginal bleeding that her gynecologist was not able to abate, despite cryoablation and other procedures. “For 90 percent of women, cryoablation cuts down the flow, but it didn't work for me ...
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