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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 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.

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. 

Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Vaginal_bleeding — Please support Wikipedia.
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64 news items

 
Huffington Post Canada
Tue, 29 Jul 2014 10:43:36 -0700

Along with the abdominal pain above you will experience vaginal bleeding and clots as your uterus 'involutes.' The feeling is gross but should only last a few days. Within a week or so the discharge turns to yellow/whit and fades over time. Most women ...

Yahoo Singapore News (blog)

Yahoo Singapore News (blog)
Tue, 29 Jul 2014 23:56:15 -0700

Caffeine should be avoided at least 30 minutes prior to measuring your blood pressure. (Thinkstock photo). The point of health screening is to detect certain conditions before they show symptoms. Early detection and treatment can result in better ...

KHOU

KHOU
Tue, 29 Jul 2014 04:03:45 -0700

Vizedom also believes Onyenweaku did the same thing to the elderly woman twice before based on the woman's instances of vaginal bleeding, something that only happened when Onyenweaku cared for her. After the rape, the victim was taken to the ...
 
The American Bazaar
Tue, 29 Jul 2014 11:11:15 -0700

Anurita became very sick and was not able to defend herself well, when Manoj violently raped her in his office by forcing himself on her and scratching her inside which caused her to have heavy vaginal bleeding and then raped her. After the rape ...
 
Healio
Mon, 28 Jul 2014 14:35:44 -0700

Vaginal bleeding was more common among women assigned estrogen compared with placebo (P<.001). Other adverse events, including serious adverse events, did not differ based on treatment. “The North American Menopause Society and other groups ...
 
Asian Tribune
Mon, 28 Jul 2014 07:03:45 -0700

She became very sick and was not able to defend herself when Manoj violently raped her by forcing himself on her and scratching her that caused heavy vaginal bleeding and then raped her. After the rape, Anurita was devastated and was in severe pain ...
 
Huffington Post Canada
Thu, 24 Jul 2014 08:41:29 -0700

"Women who are good candidates for hormone therapy are close to menopause, typically ages 50 to 59, are in good health, do not have cancer, liver disease, unexplained vaginal bleeding, or a history of heart disease or blood clots,” she says. The risks ...
 
SunHerald.com
Wed, 23 Jul 2014 20:56:15 -0700

Common signs are abnormal vaginal bleeding or discharge, pain with urination and sex, and pelvic pains. The National Cancer Institute (1-800-4-CANCER) offers a free booklet at cancer.gov. To write to Annie's Mailbox, send to c/o Creators Syndicate, 737 ...
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