Vaginal bleeding is a problem that every woman has to encounter frequently. Normal physiological vaginal bleeding such as normal menstruation and postpartum malignant dew is not harmful to health. However, abnormal vaginal bleeding is a different story, especially when it is associated with tumors of the female reproductive system, which, in addition to causing damage to the body, is a precursor to many benign and malignant tumors. In most cases, many women ignore it because they are not aware of its harmful effects and are ashamed to talk about it, so they are diagnosed at an advanced stage and miss the best time for treatment. Here we will discuss several common tumors of the female reproductive system that cause abnormal vaginal bleeding. 1. Uterine fibroids Uterine fibroids are the most common benign tumors of the female reproductive organs. They are common in women aged 30-50 years old and rare under 20 years old. Its most common symptom is abnormal vaginal bleeding. About 1/3 of patients with fibroids experience abnormal vaginal bleeding. The manifestations of vaginal bleeding caused by fibroids vary and are mainly related to the site of growth of the fibroid and the presence of degeneration, infection, and tissue necrosis. Most of them are characterized by increased menstrual flow and prolonged menstrual periods, while a few have shortened menstrual cycles or irregular vaginal bleeding. There are many reasons for vaginal bleeding caused by fibroids. Large interstitial fibroids and submucosal fibroids can increase the size of the uterine cavity and deform the uterine lining, which affects the contraction of the uterus and also squeezes the veins near the tumor, leading to congestion and expansion of the endometrial venous plexus, thus causing increased menstrual flow and prolonged periods. In particular, submucosal fibroids often manifest as acute heavy vaginal bleeding or prolonged dripping of small amounts of vaginal bleeding. If infection and tissue necrosis are present, it may also manifest as a hematopoietic discharge. Long-term increased menstrual flow may lead to anemia, weakness and palpitations, which can seriously affect women’s health. Once the above mentioned symptoms appear, gynecological examination and ultrasound should be performed in time for diagnosis and corresponding treatment. 2. Cervical intraepithelial lesions and cervical cancer Cervical intraepithelial lesions is a general term for a group of precancerous lesions closely related to cervical infiltrative cancer. It often occurs in women aged 25-35. High-grade intraepithelial lesions are considered precancerous because they have malignant potential to develop into cervical invasive carcinoma. Cervical cancer is the most common gynecologic malignancy and is the leading cause of cancer death in women, with a high incidence at the age of 50-55. Cervical cancer is also the most common malignant tumor causing irregular vaginal bleeding in women, and its harmful effects on women’s health cannot be overstated. Vaginal bleeding in cervical intraepithelial lesions and cervical cancer is often contact bleeding, i.e., vaginal bleeding after intercourse or gynecological examination, and about 70%-80% of patients have this symptom. The amount of bleeding may be more or less depending on the size of the lesion, the degree of tumor tissue rupture, and the invasion of interstitial blood vessels, and generally has the characteristic of less followed by more. In early stage, the bleeding may be a small amount or bloody leucorrhea, but in late stage, the lesion may break down and invade large blood vessels, resulting in massive bleeding and even life-threatening. In addition, there are also symptoms such as increased bloody vaginal discharge, prolonged menstruation, increased menstrual flow, and irregular vaginal bleeding after menopause. In recent years, with the continuous progress of research on the etiology of cervical cancer, it is clear that cervical cancer is a disease after viral infection, and the treatment of precancerous lesions and early cervical cancer is obvious, and regular gynecological examination and cervical cancer screening are effective means to prevent and treat cervical cancer. Once symptoms such as contact vaginal bleeding appear, timely consultation should be made and standardized three-step diagnosis should be performed, i.e. cervical cytology, high-risk HPV examination and HPV genotyping can detect abnormalities, and further cervical multi-point biopsy or colposcopic biopsy can be performed to obtain pathological histological evidence for early and correct diagnosis and treatment. Endometrial cancer is a group of epithelial malignant tumors that occur in the endometrium, also known as uterine body cancer, with endometrial adenocarcinoma being the most common. It is one of the three major malignant tumors of female genital tract, accounting for 20%-30% of female genital tract malignant tumors. It is a common malignant tumor in gynecology, second only to cervical cancer, with an average age of about 60 years, mostly seen in older women. Some research results show that obesity, tamoxifen use, older age, diabetes, hypertension, and exogenous estrogen use are the main high-risk factors for endometrial cancer. Moreover, the older the patient is and the longer the age of menopause, the higher the probability of developing malignant tumors. Postmenopausal vaginal bleeding is a common manifestation of endometrial cancer, and about 10% of postmenopausal vaginal bleeding is caused by endometrial cancer. This type of bleeding manifests itself as a generally small amount, sometimes spotty, continuous or intermittent. Those who are not yet menopausal or in the transition to menopause often present with increased menstruation, prolonged periods and menstrual disorders. It should be noted that although not all postmenopausal vaginal bleeding is malignant, malignancies, especially endometrial cancer, need to be ruled out first. 4. Ovarian and fallopian tube cancer Ovarian and fallopian tube cancer is a type of malignant tumor that occurs in the ovaries and fallopian tubes. Different histological types of tumors have different ages of predilection; germ cell tumors are most common in women under 20 years of age, junctional tumors often occur in women between 30 and 40 years of age, and epithelial ovarian cancer mostly occurs after 50 years of age. The clinical manifestations of ovarian and fallopian tube cancer are different from other reproductive system tumors, which are difficult to be detected early because of their insidious location. The most common clinical manifestations are pelvic masses and gastrointestinal symptoms. Only a few patients may have irregular vaginal bleeding. In this group of patients, the possibility of ovarian granulosa cell tumor should be considered. Ovarian granulosa cell tumor is a type of interstitial tumor of the ovarian cords, accounting for about 2%-5% of all ovarian malignant tumors, characterized by low grade malignancy and distant recurrence. Due to its estrogen-secreting properties, endometrial atypical hyperplasia and even endometrial adenocarcinoma are often combined with long-term stimulation by estrogen. Oestrogen production leads to menstrual disorders, excessive menstruation, irregular bleeding and post-menopausal bleeding in the early stages of the disease. Enlarged breasts and breast lumps are also common symptoms. Early detection of tumor is facilitated by comprehensive scraping and hormone measurement. 5.Grape sarcoma of the genital system Grape sarcoma is a variant of embryonic rhabdomyosarcoma, which is a more infantile differentiated tumor. Most of them originate from the female genital tract, with those occurring in the vagina being more common and those occurring in the cervix being less common. It is a rare soft tissue sarcoma that occurs in children and adolescents, mostly in young girls under 5 years of age, and occasionally in older adults, and is highly malignant and prone to early metastasis. It often presents as irregular vaginal bleeding or fluid discharge in young girls. On physical examination, a grape-like, polypoid or multinodular mass is seen filling the vagina and sometimes protruding from the external vaginal opening. Early detection and treatment can lead to long-term survival. Health is a constant pursuit. Women’s health is more important for the happiness of a family. We hope that all women will pay attention to abnormal vaginal bleeding and go to the hospital for examination in time to avoid delaying the diagnosis and missing the best time for treatment! May all female friends have a healthy body and a bright future!