Bleeding can occur from any part of the female genital tract, including the vagina, cervix, body of the uterus and fallopian tubes. Although the majority of bleeding comes from the uterine body, it is called “vaginal bleeding” regardless of where it originates, except for normal menstruation. What we need to understand is that abnormal vaginal bleeding alone is a warning of a different gynecological condition.
Common causes
1. Ovarian endocrine dysfunction: mainly includes anovulatory dysfunctional uterine bleeding and ovulatory menstrual dysfunction, in addition to follicular rupture during menstruation and a brief drop in estrogen levels that can also lead to uterine bleeding.
2. Pregnancy-related vaginal bleeding: common include miscarriage, ectopic pregnancy, gravidity, and partial residual placenta after delivery.
3.Inflammatory diseases of genitalia: vaginitis, acute cervicitis, cervical polyps and endometritis, etc.
4.Genital tumors: uterine fibroids cause vaginal bleeding most commonly benign tumors, other almost malignant tumors, such as vaginal cancer, cervical cancer, etc.
5.Injury, foreign body and exogenous hormone: genital tract trauma, hymen or vaginal injury due to sexual intercourse, placement of functional birth control device, “breakthrough bleeding” caused by estrogen or progestin drugs.
6. Vaginal bleeding related to systemic diseases: such as thrombocytopenic purpura, etc.
Manifestation
1.Increased menstrual flow: The menstrual cycle is basically normal, but increased menstrual flow >80ml or prolonged periods are typical symptoms of uterine fibroids, others are also seen in ovulatory menstrual disorders, adenomyosis, etc.
2.Vaginal bleeding with irregular cycles: mostly anovulatory dysfunctional uterine bleeding, but perimenopausal women should pay attention to exclude early endometrial cancer
3.Long-term persistent vaginal bleeding without any identifiable cycle: Mostly due to malignant tumors of the reproductive tract, first consider the possibility of cervical cancer and endometrial cancer
4.Vaginal bleeding after menopause: mostly occurs in women of childbearing age and should be considered as pregnancy-related diseases, such as miscarriage and ectopic pregnancy, etc. Malignant tumors of the reproductive tract should be excluded when it occurs during the perimenopause.
5.Vaginal bleeding with increased leucorrhea: generally consider advanced cervical cancer, etc.
6.Contact bleeding: If fresh blood appears immediately after sexual intercourse or vaginal examination, acute cervicitis, cervical cancer or submucosal fibroid should be considered.
7.Intermenstrual bleeding: If it occurs 14-15 days before the next menstrual period and lasts for 3-4 days, it is usually ovulatory bleeding.
8.Vaginal bleeding before or after menstruation: If the bleeding is very small and lasts for 2-3 days, it is mostly caused by the shedding of endometrium after menopause; if the bleeding does not last for a long time, endometrial cancer should be considered.
9. Intermittent vaginal discharge of bloody fluid: Be alert to fallopian tube cancer
Vaginal bleeding after trauma
In addition, age is also very important to identify vaginal bleeding. In newborns, it is mostly caused by the sudden drop of estrogen after the baby leaves the mother and the endometrium is shed; in young girls, precocious puberty or malignant tumor of the reproductive tract is considered; in adolescents, anovulatory dysfunctional uterine bleeding is most common; in women of childbearing age, pregnancy-related diseases should be considered first; in perimenopause, anovulatory functional uterine bleeding is most common, but malignant tumor of the reproductive tract should be excluded first.