Abnormal Vaginal Bleeding
Key points
- Total menstrual blood loss is usually less than 80mL.
- Most abnormal vaginal bleeding results from hormonal abnormalities in the hyothalmic-pitutary-ovarian axis, but bleeding may also result from structural gynecologic disorders.
- Women who experience vaginal bleeding during or following sexual intercourse should always visit their doctor to determine the cause of the bleeding.
- Many women have some amount of vaginal bleeding during pregnancy.
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?
Written and revised by
David Cohen, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
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