Vaginal Bleeding

Bleeding from vagina is one of the most common complaints in gynecological ambulance. Bleeding is a normal sign of more or less regular menstrual cycle, but it can also be a serious symptom of many diseases.

Causes

Menstrual bleeding

Menstruation is the most common and natural cause of gynecological bleeding. It is a part of menstrual cycle. It starts on average at 12 years of age and ends by so-called menopause. Menstruation is not always regular and it has individual intensity. Stronger menstruation is unpleasant and can be accompanied by considerable blood loss and iron-deficiency anemia. Menstruation irregularities are usually solved by administration of hormonal contraception.

Gynecological inflammations

Inflammation processes affecting vagina, cervix and uterus may be associated with bloody discharge. Abdominal pain and fever are often present as well.

Sexual intercourse

Sexual intercourse can lead to irritation of vaginal mucosa and may be followed by mild bleeding. Sometimes, cervical cancer can start bleeding after the intercourse.

Defloration

The rupture of hymen is usually (but not always) associated with mild pain and bleeding. It is completely natural cause of vaginal bleeding.

Malignant diseases

Gynecological cancers can obviously manifest by bleeding. This includes vaginal cancer, cervical cancer and uterine cancer. Especially bloody discharge by women after menopause must always lead to gynecological examination.

Benign lesions in the womb

Various benign womb polyps and uterine fibroids (myomas) can also bleed. Polyp discovery is not a big deal; hysteroscopy is performed with polyp tissue removal. Symptomatic uterine fibroids are usually operated; sometimes the whole womb must be removed (hysterectomy).

Ectopic pregnancy

Bleeding usually occurs when fertilized egg nests in abnormal localization outside womb (most often fallopian tubes). Affected woman does not get expected menstruation (because she is pregnant) and bleeding occurs as a complication of ectopic pregnancy. It is quite insidious, because such bleeding may be mistaken for delayed menstruation. Other possible symptom is abdominal pain. Ectopic pregnancy must be regarded as potentially life-threatening condition and every suspicion must be cautiously examined.

Abortion

Spontaneous abortion (and artificial abortion as well) is associated with vaginal bleeding. The source of bleeding is in this case injured uterus mucosa and embryonic tissue.

Childbirth

Gynecological bleeding usually accompanies childbirth when placenta is separated from the womb (placental abruption). In normal ongoing childbirth bleeding is not large and does not significantly threaten a woman’s life.

Blood clotting disorders

When there is impaired clotting system for some reason, the risk of bleeding from gynecologic tract is higher. It is usually caused by anticoagulation drugs. Inherited causes of blood clotting disorders are rare (e.g. hemophilia).

Diagnostic approach

The basis is medical history and physical examination done by gynecologist. Blood tests are usually performed to acquire information about erythrocyte numbers and hemoglobin concentration (i.e. about anemia presence). Blood test can be also used to measure pregnancy hormone* level to exclude ectopic pregnancy. During physical examination vaginal cavity and cervix can be examined using gynecological tools (so-called mirrors). Abdominal ultrasound or, if needed, computed tomography, can inform us about pelvic organs pathologies. If there is suspicion of a uterine lesion, hysteroscopy may be done.

 

* Pregnancy hormone is also known as Human Chorionic Gonadotropin (hCG). Its blood concentration sharply rises during pregnancy including ectopic one and by some very rare tumors producing this hormone.