View source for Vaginal bleeding

{{Infobox symptom |
  Name        = Vaginal bleeding |
  ICD10       = N92-N93, {{ICD10|N|93|8|n|80}} |
  ICD9        = |
}}
'''Vaginal bleeding''' refers to bleeding in females that is 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. 

==Definition==
Blood loss ''per vaginam'' ([[Latin]]: from the [[vagina]]) (PV) typically arises from the lining of the uterus ([[endometrium]]), but may arise from [[uterus|uterine]] or [[cervix|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.

== Differential diagnosis ==
=== 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 fibroid]]s (leiomyoma) are benign [[tumor]]s 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.
* In recently [[pregnant]] women who have been delivered of a baby or who have had a miscarriage, vaginal bleeding may be a sign of [[endometritis]] or [[retained products of conception]].

=== 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 [[medical ultrasonography|ultrasound]] is required to separate the two causes. Bleeding in early pregnancy may be a sign of a [[threatened miscarriage|threatened]] or [[incomplete miscarriage|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 ===
All vaginal bleeding in postmenopausal women should be medically assessed. The [[differential diagnosis]] is:{{fact|date=September 2008}}
* 30% unopposed estrogen
* 30% atrophic endometritis / vaginitis
* 15% [[endometrial cancer]]
* 10% endometrial polyps or cervical polyps
* 5% endometrial hyperplasia
* 10% other

== Diagnostic approach ==
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]].

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 pill]]s.

== 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 transfusion]]s to improve the anemia.

{{Diseases of the pelvis and genitals}}


[[Category:Noninflammatory disorders of female genital tract]]
[[Category:Symptoms]]

[[ja:不正出血]]
[[pl:Krwawienia z dróg rodnych]]
[[ru:Маточное кровотечение]]
[[uk:Метроррагія]]
[[Category:2Fix]]