Vaginal bleeding

You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.

Vaginal bleeding Classification and external resources
ICD-10	N92-N93

WikiDoc Resources for Vaginal bleeding
Articles
Most recent articles on Vaginal bleeding Most cited articles on Vaginal bleeding Review articles on Vaginal bleeding Articles on Vaginal bleeding in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Vaginal bleeding Images of Vaginal bleeding Photos of Vaginal bleeding Podcasts & MP3s on Vaginal bleeding Videos on Vaginal bleeding
Evidence Based Medicine
Cochrane Collaboration on Vaginal bleeding Bandolier on Vaginal bleeding TRIP on Vaginal bleeding
Clinical Trials
Ongoing Trials on Vaginal bleeding at Clinical Trials.gov Trial results on Vaginal bleeding Clinical Trials on Vaginal bleeding at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Vaginal bleeding NICE Guidance on Vaginal bleeding NHS PRODIGY Guidance FDA on Vaginal bleeding CDC on Vaginal bleeding
Books
Books on Vaginal bleeding
News
Vaginal bleeding in the news Be alerted to news on Vaginal bleeding News trends on Vaginal bleeding
Commentary
Blogs on Vaginal bleeding
Definitions
Definitions of Vaginal bleeding
Patient Resources / Community
Patient resources on Vaginal bleeding Discussion groups on Vaginal bleeding Patient Handouts on Vaginal bleeding Directions to Hospitals Treating Vaginal bleeding Risk calculators and risk factors for Vaginal bleeding
Healthcare Provider Resources
Symptoms of Vaginal bleeding Causes & Risk Factors for Vaginal bleeding Diagnostic studies for Vaginal bleeding Treatment of Vaginal bleeding
Continuing Medical Education (CME)
CME Programs on Vaginal bleeding
International
Vaginal bleeding en Espanol Vaginal bleeding en Francais
Business
Vaginal bleeding in the Marketplace Patents on Vaginal bleeding
Experimental / Informatics
List of terms related to Vaginal bleeding

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Vaginal bleeding refers to bleeding in females that are 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.

Anatomy

Blood loss per vaginam (Latin: from the vagina) 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 women can identify the difference. It can also be a sign of vaginal cancer.

Causes

Bleeding in Children

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

• Menstruation. Exceptionally heavy bleeding during periods is termed menorrhagia or hypermenorrhea, while light bleeding is called hypomenorrhea.
• If bleeding occurs between periods, this is not necessarily pathological, but it is termed intermenstrual bleeding. If no period can be identified due to the unpredictable bleeding, metrorrhagia is used.
• 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.
• Uterine fibroids (leiomyoma) are benign tumors of the uterus.
• Cervical cancer may occur at premenopausal age, and often presents with "contact bleeding" (e.g. after sexual intercourse)
• Uterine cancer will lead to irregular and often prolonged bleeding.

Pregnant women

During pregnancy: mild to moderate blood loss may be due to 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

Any vaginal bleeding after the menopause needs to be medically assessed.

• Atrophy of the endometrium may cause bleeding
• Endometrial cancer often presents with blood loss in postmenopausal women

Investigation

The diagnosis can often be made on the basis of the bleeding history, physical examination, and other medical tests as appropriate. Typically a pregnancy test and additional hormonal tests, a Pap smear, a transvaginal ultrasound are needed. 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.

Differential Diagnosis

In alphabetical order. ^{[1] [2]}

• Abortion
• Adherent placental residue
• Adnexitis
• Adrenal disease
• Atonic secondary bleeding
• Carcinoma
• Cervical Cancer
• Cervical ectopia
• Cervical erosion
• Cervical neoplasms
• Cervical polyp
• Cervicitis
• Chorionepithelioma
• Colpitis Senilis
• Corpus luteum deficiency syndrome
• Ectopic Pregnancy
• Endometrial polyps
• Endometriosis
• Endometritis
• Estrogen-progestogen therapy
• Estrogen breakthrough bleeding
• Fibrinogen deficiency
• Follicle persistence
• Granulosa cell tumor
• Hydatidiform mole
• Hypothalamic or pituitary lesion
• Inadequate corpus luteum
• Injuries
• Intrauterine device (IUD)
• Lacerated placenta
• Midcycle ovulatory bleeding
• Myoma
• Neoplasms
• Placenta Previa
• Postcoital hemorrhage
• Premature placental abruption
• Prolapsed uterus
• Rupture hemorrhage
• Ruptured uterus
• Stress/psychogenic factors
• Thyroid disease
• Trauma
• Uterine adenomytosis
• Uterine leiomyomas
• Vaginal Cancer
• Vaginal infections
• Vaginal varices
• Varicosis of the vagina
• Velamentous insertion
• Vulvar Cancer

Treatment

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

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

v • d • e Symptoms and signs (R00-R69, 780-789)
Circulatory and respiratory systems	Tachycardia - Bradycardia - Palpitation - Heart murmur - Nosebleed - Hemoptysis - Cough - abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) - Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Bruit
Digestive system and abdomen	Abdominal pain - Acute abdomen - Nausea - Vomiting - Heartburn - Dysphagia - Flatulence - Burping - Fecal incontinence - Encopresis - Hepatomegaly - Splenomegaly - Hepatosplenomegaly - Jaundice - Ascites - Fecal occult blood - Halitosis
Skin and subcutaneous tissue	disturbances of skin sensation (Hypoesthesia, Paresthesia, Hyperesthesia) - Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration
Nervous and musculoskeletal systems	abnormal involuntary movements (Tremor, Spasm, Fasciculation, Athetosis) - Gait abnormality - lack of coordination (Ataxia, Dysmetria, Dysdiadochokinesia, Hypotonia) - Tetany - Meningism - Hyperreflexia
Urinary system	Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia
Cognition, perception, emotional state and behaviour	Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo - smell and taste (Anosmia, Ageusia, Parosmia, Parageusia)
Speech and voice	speech disturbances (Dysphasia, Aphasia, Dysarthria) - symbolic dysfunctions (Dyslexia, Alexia, Agnosia, Apraxia, Acalculia, Agraphia) - voice disturbances (Dysphonia, Aphonia)
General symptoms and signs	Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise - Fatigue - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing

v • d • e WikiDoc Research Resources for Vaginal bleeding
Articles on Vaginal bleeding	Most recent articles on Vaginal bleeding • Most cited articles on Vaginal bleeding • Review articles on Vaginal bleeding • Articles on Vaginal bleeding in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Vaginal bleeding	Powerpoint slides on Vaginal bleeding • Images of Vaginal bleeding • Photos of Vaginal bleeding • Podcasts & MP3s on Vaginal bleeding • Videos on Vaginal bleeding
Evidence Based Medicine Regarding Vaginal bleeding	Cochrane Collaboration on Vaginal bleeding • Bandolier on Vaginal bleeding • TRIP on Vaginal bleeding
Cost Effectiveness of Vaginal bleeding	Cost Effectiveness of Vaginal bleeding
Clinical Trials Involving Vaginal bleeding	Ongoing Trials on Vaginal bleeding at Clinical Trials.gov • Trial results on Vaginal bleeding • Clinical Trials on Vaginal bleeding at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Vaginal bleeding	US National Guidelines Clearinghouse on Vaginal bleeding • NICE Guidance on Vaginal bleeding • NHS PRODIGY Guidance • FDA on Vaginal bleeding • CDC on Vaginal bleeding
Textbook Information on Vaginal bleeding	Books and Textbook Information on Vaginal bleeding
Pharmacology Resources on Vaginal bleeding	Dosing of Vaginal bleeding • Drug interactions with Vaginal bleeding • Side effects of Vaginal bleeding • Allergic reactions to Vaginal bleeding • Overdose information on Vaginal bleeding • Carcinogenicity information on Vaginal bleeding • Vaginal bleeding in pregnancy • Pharmacokinetics of Vaginal bleeding •
Genetics, Pharmacogenomics, and Proteinomics of Vaginal bleeding	Genetics of Vaginal bleeding • Pharmacogenomics of Vaginal bleeding • Proteomics of Vaginal bleeding
Newstories on Vaginal bleeding	Vaginal bleeding in the news • Be alerted to news on Vaginal bleeding • News trends on Vaginal bleeding
Commentary on Vaginal bleeding	Blogs on Vaginal bleeding
Patient Resources on Vaginal bleeding	Patient resources on Vaginal bleeding • Discussion groups on Vaginal bleeding • Patient Handouts on Vaginal bleeding • Directions to Hospitals Treating Vaginal bleeding • Risk calculators and risk factors for Vaginal bleeding
Healthcare Provider Resources on Vaginal bleeding	Symptoms of Vaginal bleeding • Causes & Risk Factors for Vaginal bleeding • Diagnostic studies for Vaginal bleeding • Treatment of Vaginal bleeding
Continuing Medical Education (CME) Programs on Vaginal bleeding	CME Programs on Vaginal bleeding
International Resources on Vaginal bleeding	Vaginal bleeding en Espanol • Vaginal bleeding en Francais
Business Resources on Vaginal bleeding	Vaginal bleeding in the Marketplace • Patents on Vaginal bleeding
Informatics Resources on Vaginal bleeding	List of terms related to Vaginal bleeding