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.
124186 videos foundNext > 

Evaluation of Abnormal Bleeding (Gynecology - Abnormal Vaginal Bleeding)

Full description and additional information at http://medtwice.com/evaluation-of-abnormal-vaginal-bleeding/ Free medical videos at http://www.MedTwice.com.

ER vaginal bleeding

see the typical ER patient complain about her bleeding.

Causes of Abnormal Vaginal Bleeding

There are many possible causes of abnormal unprovoked vaginal bleeding, such as, ovulatory dysfunction, endometrial polyps, uterine fibroids, adenmyosis, end...

Vaginal Bleeding During Pregnancy

Treatment of Abnormal Vaginal Bleeding (Gynecology - Abnormal Vaginal Bleeding)

Full description and additional information at http://medtwice.com/treatment-of-abnormal-vaginal-bleeding Free medical videos at http://www.MedTwice.com.

What is Abnormal Vaginal Bleeding? (Gynecology - Abnormal Vaginal Bleeding)

Full description and additional information at http://medtwice.com/what-is-abnormal-vaginal-bleeding Free medical videos at http://www.MedTwice.com.

Pregnancy : Vaginal Bleeding in Pregnancy - USMLE Step 2 Review

http://bit.ly/1inR90D It is common for women to experience bleeding during pregnancy. This is so especially during the first half of the pregnancy. While the...

Deranged - Infernal Vaginal Bleeding

beautiful.

Is vaginal bleeding normal during pregnancy? When should I be worried about it?

If a patient experience's bleeding during pregnancy, this is not always normal. A patient should be aware that this could be a sign of a miscarriage, however...

Vaginal Bleeding During Pregnancy: Is This Common? - Dr. Carrillo

Dr. Carrillo shares if you should experience vaginal bleeding during pregnancy and explains when your menstrual cycle will return after a miscarriage. For mo...

124186 videos foundNext > 

130 news items

Healio

Healio
Tue, 21 Oct 2014 06:22:47 -0700

The trials assessed: vaginal dryness, dyspareunia, vulvar and/or vaginal irritation/itching, difficult and/or painful urination and vaginal bleeding associated with sexual activity. Symptoms were self-reported at baseline, week 4 and week 12; those ...

New York Times

New York Times
Wed, 24 Sep 2014 18:31:30 -0700

For the second time this month, video of a violent confrontation between the police and residents in Sunset Park, Brooklyn, has aroused concerns in the neighborhood about arrest tactics. The latest video emerged after a fight early Saturday morning.

Renal and Urology News

Renal and Urology News
Mon, 20 Oct 2014 11:45:00 -0700

Ebola hemorrhagic fever, which is accompanied by hematemesis, melena, hematuria, epistaxis, and vaginal bleeding, might remind us of a scary apocalyptic movie in which victims ooze blood from every orifice. The nature of Ebola hemorrhagic fever is such ...
 
The Island.lk (subscription)
Wed, 01 Oct 2014 20:56:15 -0700

Menopause is the cessation of menstruation for a period of one year. This is a natural condition dueto hormonal changes which occur in the woman's body during this period. The average age of menopause is 51 years, but it may range from 45 to 55 years.
 
The Inquisitr
Sat, 18 Oct 2014 17:45:00 -0700

“Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures ...

Legal Examiner

Legal Examiner
Thu, 16 Oct 2014 06:16:08 -0700

Early symptoms may include nausea and vomiting with pain, cramping, and light vaginal bleeding. Without treatment, the Fallopian tube may rupture, causing life-threatening internal bleeding. The standard treatment for an ectopic pregnancy depends on ...
 
AllAfrica.com
Fri, 17 Oct 2014 04:15:00 -0700

In an interview with OurHealth, Decia admitted that although she had symptoms such as abnormal vaginal bleeding and abdominal pain, she had refused to go for cervical cancer screening because she thought she would be made to take an HIV test.

Detroit Free Press

Detroit Free Press
Sat, 11 Oct 2014 21:14:10 -0700

Those with high PCE exposure were also at increased risk for vaginal bleeding. There was no link between PCE exposure and preeclampsia or smaller-than-normal infants, according to the study published recently in the journal Environmental Health.
Loading

Oops, we seem to be having trouble contacting Twitter

Support Wikipedia

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