digplanet beta 1: Athena
Share digplanet:

Agriculture

Applied sciences

Arts

Belief

Business

Chronology

Culture

Education

Environment

Geography

Health

History

Humanities

Language

Law

Life

Mathematics

Nature

People

Politics

Science

Society

Technology

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 females can identify the difference. It can also be a sign of vaginal cancer.

Differential diagnosis[edit]

There are many potential causes for abnormal vaginal bleeding.

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]

Most unusual bleeding or irregular bleeding (metrorrhagia) in premenopausal women is caused by changes in the hormonal balance of the body. These changes are not pathological. Exceptionally heavy bleeding during menstruation is termed menorrhagia or hypermenorrhea, while light bleeding is called hypomenorrhea. Women on hormonal contraceptives can experience breakthrough bleeding and/or withdrawal bleeding. Withdrawal bleeding occurs when a hormonal contraceptive or other hormonal intake is discontinued.[1]

There are pathological causes of unusual vaginal bleeding as well. Dysfunctional uterine bleeding is a common cause of menorrhagia and irregular bleeding. It is due to a hormonal imbalance, and symptoms can be managed by use of hormonal contraception (although hormonal contraception does not treat the underlying cause of the imbalance). If it is due to polycystic ovary syndrome, weight loss may help, and infertility may respond to clomifene citrate.[citation needed] Uterine fibroids (leiomyoma) are benign tumors of the uterus that cause bleeding and pelvic pain in approximately 30% of affected women. Adenomyosis, a condition in which the endometrial glands grow into the uterine muscle, can cause dysmenorrhea and menorrhagia.[2] Cervical cancer may occur at premenopausal age, and often presents with "contact bleeding" (e.g. after sexual intercourse). Uterine cancer leads to irregular and often prolonged bleeding. In recently pregnant women who have delivered or who have had a miscarriage, vaginal bleeding may be a sign of endometritis or retained products of conception.

Pregnant women[edit]

Vaginal bleeding occurs during 15-25% of first trimester pregnancies. Of these, half go on to miscarry and half bring the fetus to term.[3] 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]

Clinical evaluation[edit]

Sonohysterography performed because of postmenopausal bleeding. In serial images, polyps would be more immobile than freely moving debris within the uterine cavity which are seen in the image.

The cause of the bleeding can often be discerned on the basis of the bleeding history, physical examination, and other medical tests as appropriate. The physical examination for evaluating vaginal bleeding typically includes visualization of the cervix with a speculum, a bimanual exam, and a rectovaginal exam. These are focused on finding the source of the bleeding and looking for any abnormalities that could cause bleeding. In addition, the abdomen is examined and palpated to ascertain if the bleeding is abdominal in origin. Typically a pregnancy test is performed as well.[2] 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.

In an emergency or acute setting, vaginal bleeding can lead to hypovolemia.[2]

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.

Postmenopausal bleeding[edit]

In postmenopausal bleeding, guidelines from the United States consider transvaginal ultrasonography to be an appropriate first-line procedure to identify which women are at higher risk of endometrial cancer. A cut-off threshold of 3 mm or less of endometrial thickness should be used for in women with postmenopausal bleeding in the following cases:

A cut-off threshold of 5 mm or less should be used for women on sequential hormone replacement therapy consisting both of an estrogen and a progestagen.[4]

It the endometrial thickness equals the cut-off threshold or is thinner, and the ultrasonography is otherwise reassuring, no further action need be taken. Further investigations should be carried out if symptoms recur.[4]

If the ultrasonography is not reassuring, hysteroscopy and endometrial biopsy should be performed. The biopsy may be obtained either by curettage at the same time as inpatient or outpatient hysteroscopy, or by using an endometrium sampling device such as a pipelle which can practically be done directly after the ultrasonography.[4]

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.[2] 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 c d Morrison, LJ; Spence, JM (2011). "Vaginal Bleeding in the Nonpregnant Patient". Tintinalli's Emergency Medicine: A Comprehensive Study Guide (New York City: McGraw-Hill). 
  3. ^ 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. 
  4. ^ a b c Investigation of post-menopausal bleeding. A national clinical guideline.. Updated by ECRI Institute on June 8, 2012.

Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Vaginal_bleeding — Please support Wikipedia.
This page uses Creative Commons Licensed content from Wikipedia. A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia.

90 news items

 
Daily Journal Online
Thu, 07 Aug 2014 22:11:01 -0700

Once menopause begins, vaginal bleeding is not normal. Post-menopausal bleeding (PMB) can happen for many reasons. It may result from infection or injury. Non-cancerous growths such as polyps and fibroids can cause PMB. So can bleeding disorders or ...
 
The Lamar Ledger
Mon, 04 Aug 2014 13:58:16 -0700

Once menopause begins, vaginal bleeding is not normal. Post-menopausal bleeding (PMB) can happen for many reasons. It may result from infection or injury. Non-cancerous growths such as polyps and fibroids can cause PMB. So can bleeding disorders or ...

Gossip Extra

Gossip Extra
Sun, 03 Aug 2014 01:13:27 -0700

It's yet another Gossip Extra exclusive: Michael Lohan says former tabloid reporter Kate Major, who's pregnant with their second child, has had two episodes of vaginal bleeding in four days and has not been receiving adequate medical treatment. “This ...
 
Foreign Policy (blog)
Wed, 20 Aug 2014 10:13:51 -0700

... "Inflammation caused by infection is often greater for women than for men." Similarly, Anker noted in a 2011 WHO report, "A frequent mistake is to undercount the relative importance of symptoms that can only occur in one sex, such as vaginal ...

TheHealthSite

TheHealthSite
Tue, 19 Aug 2014 09:27:22 -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 ...
 
Foreign Policy (blog)
Wed, 20 Aug 2014 14:30:49 -0700

Similarly, Anker noted in a 2011 WHO report, "A frequent mistake is to undercount the relative importance of symptoms that can only occur in one sex, such as vaginal bleeding in dengue."*. "You get these really interesting observations about Ebola, too ...
 
Newsday
Tue, 19 Aug 2014 02:56:15 -0700

Presently we can only encourage women to seek medical evaluation if they experience warning signs of ovarian cancer such as abnormal vaginal bleeding or discharge, pelvic or abdominal pain, quickly feeling full when eating, frequent bloating or changes ...
 
Modesto Bee
Fri, 15 Aug 2014 23:56:15 -0700

Myth. Early CerCA often causes few symptoms. This is why regular screening is so important. More advanced CerCA might cause vaginal bleeding after sex or bleeding between menstrual cycles. Myth or Fact: CerCA is a “sexually transmitted disease.” Fact.
Loading

Oops, we seem to be having trouble contacting Twitter

Talk About Vaginal bleeding

You can talk about Vaginal bleeding with people all over the world in our discussions.

Support Wikipedia

A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia. Please add your support for Wikipedia!