What is abnormal vaginal bleeding?
Abnormal bleeding includes:
Menses that are prolonged Menonhagia
Menses that are excessive Hypermenorrhea or Menonhagia
Menses that are too frequent Polymenorrhea
Vaginal bleeding that is not related to Menses, occurring frequently between menses mentrorrhagia or post menopausally
In women over 50 years, post menopausal bleeding after 6 months after the last normal menses should be evaluated.
Total menstrual blood loss is usually less than 80mL. Prolonged or excessive blood loss, regardless of the cause may result in iron deficiency and anemia.
What causes abnormal vaginal bleeding?
Most abnormal vaginal bleeding results from hormonal abnormalities in the hyothalmic-pitutary-ovarian axis, but bleeding may also result from structural gynecologic disorders. With hormonal causes, ovulation does not occur or occurs infrequently; as a result estrogen, unopposed by progesterone, stimulates endometrial growth. As a result, the endometrial sloughs and bleeds irregularly, incompletely, and sometimes excessively or for a long time.
Common causes of vaginal bleeding vary by age and menstrual status:
In INFANTS common causes—- Endometrial estrogens
In children common causes—- Trauma, foreign bodies with vaginitis, prolapsed urethral meatus, precocious puberty with premature menses
Women of reproductive age with syncope or hemorrhagic shock—- Ruptured ectopic pregnancy. Women of reproductive age with positive pregnancy test—- Spontaneous complete or incomplete abortion, ectopic pregnancy, gestational trophoblastic disease, endomentritis secondary to retained products of conception
Women of reproductive age with negative pregnancy test.
Hormonally Related: Dysfunctional uterine bleeding (most common) brain lesions, drugs, (eg. Hormonal contraceptive), Hypothyroidism adrenal or ovarian tumors
Structural: Vaginal disorders (eg. Cancers, adenosis, trauma, granulomas secondary to previous surgery) Cervical (eg. Cancer, polyps, myomas, condylomata acuminate). Uterine (eg. cancers, adenomyosis such as benign invasion of myometrium by the myometrium by the endometrium, endometrial polyps, submucosa and pedunculated fibroids; occasional, delayed endometeritis secondary to retained products of conception). Ovarian (eg. Tumors)
Post-Menopausal Women: STRUCTURAL DISORDERS of the Vagina (eg. Cancer, atrophic vaginitis), cervix (eg. Cancer, polyps), uterus (eg. Endometrial cancer, atrophy, hyperplasia endomentrium greater than 5mm) polyps), or ovaries (eg. Tumors0
What Causes Vaginal Bleeding during or after Sexual Intercourse?
Vaginal bleeding may occur during or after sexual intercourse for a number of reasons including:
Injuries to the virginal wall during intercourse
Lowered estrogen levels in peri-menopausal or post menopausal women may cause the lining of the vagina to become thinned and easily inflamed or infected, and these changes can be associated with vaginal bleeding after intercourse.
Anatomical lesions, such as tumors or polyps on the cervix or vaginal wall may lead to vaginal bleeding during or after intercourse.
Women who experience vaginal bleeding during or following sexual intercourse should always visit their doctor to determine the cause of the bleeding.
What Causes Abnormal Vaginal Bleeding during pregnancy?
Many women have some amount of vaginal bleeding during pregnancy. Some studies show that up to 30% of pregnant women will experience some degree of vaginal bleeding while they are pregnant. Vaginal bleeding during pregnancy is more common with twins and other multiple gestations than with singleton pregnancies (pregnancy with one fetus). Sometimes woman experience a very scant amount of bleeding in the first two weeks of pregnancy, usually around the time of the expected menstrual period. This slight bleeding is sometimes referred to as “Implantation bleeding.” Doctors do not know for certain what causes this bleeding, but it may occur as a result of the fertilized egg implanting in the uterine wall.
The amount of bleeding, the stage of pregnancy, and any associated symptoms can all help determine the cause of vaginal bleeding in pregnancy. While vaginal bleeding in pregnancy does not signify a problem with the pregnancy, women who experience bleeding during pregnancy should always be evaluated by a doctor.
Causes of bleeding in pregnancy include MISCARRIAGE, an abnormal location of the planceta, ectopic pregnancy, cervical infection or polyp and premature labor. Chronic medical conditions and medication use can also be related to vaginal bleeding during pregnancy.
Dr. Lily Sanvee
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