Abnormal vaginal bleeding
Definitions
- Menorrhagia. Prolonged (>7 days) and/or heavy (>80 mL) uterine bleeding occurring at regular intervals.
- Metrorrhagia. Variable amounts of intermenstrual bleeding occurring at irregular but frequent intervals.
- Polymenorrhea. An abnormally short interval (<21 days) between regular menses.
- Oligomenorrhea. An abnormally long interval (>35 days) between regular menses.
Causes of abnormal vaginal bleeding
1 Reproductive tract disease
- Pregnancy-related conditions are the most common causes of abnormal vaginal bleeding in women of reproductive age (threatened, incomplete, and missed abortion [see Chapter 15]; ectopic pregnancy [see Chapter 5]; and gestational trophoblastic disease [see Chapter 34]). Implantation bleeding is also quite common at about the time of the first missed menstrual period.
- Uterine lesions commonly produce menorrhagia or metrorrhagia by increasing endometrial surface area, distorting the endometrial vasculature, or having a friable/inflamed surface.
- Cervical lesions usually result in metrorrhagia (especially postcoital bleeding) due to erosion or direct trauma.
- Iatrogenic causes include the intrauterine device (IUD), oral/injectable steroids for contraception or hormone replacement, and tranquilizers or other psychotropic drugs. Oral contraceptives are often associated with irregular bleeding during the first 3 months of use, if doses are missed or the patient is a smoker. Long-acting progesterone-only contraceptives (Depo-Provera, Nexplanon) frequently cause irregular bleeding. Some patients may be unknowingly taking herbal medications (St John’s wort, ginseng) that have an impact on the endometrium.
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