Gynecologic hemorrhage represents excessive bleeding of the

female reproductive system The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. In humans, the female reproductive system is immature at birth and develops to maturity at puberty to be able ...

. Such bleeding could be visible or external, namely bleeding from the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

, or it could be internal into the pelvic cavity or form a

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...

. Normal

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...

is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a

pregnant Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occur ...

state or during delivery is an

obstetrical hemorrhage Obstetrical bleeding is bleeding in pregnancy that occurs before, during, or after childbirth. Bleeding before childbirth is that which occurs after 24 weeks of pregnancy. Bleeding may be vaginal or less commonly into the abdominal cavity. Bleedi ...

Types

Metrorrhagia Intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. It is a cause of vaginal bleeding. In some women, menstrual spotting between periods occur ...

(metro = womb, -rrhagia = excessive flow) is

uterine bleeding Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductiv ...

at irregular intervals, particularly between the expected

menstrual period The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs ...

s. * Postcoital bleeding is vaginal bleeding after

sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...

Causes

Causes of gynecologic bleeding include:

Hormonal

Anovulation is a common cause of gynecological hemorrhage. Under the influence of estrogen the

endometrium The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional laye ...

(uterine lining) is stimulated and eventually such lining will be shed off (estrogen breakthrough bleeding). The anovulation chapter discusses its multiple possible causes. Longstanding anovulation can also lead to endometrial hyperplasia and facilitate the development of endometrial cancer.

Neoplasm

# Cancer of the uterus is always a concern, specifically when the bleeding occurs after menopause. Other types of cancer include

cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...

; bleeding in that case can sometimes be triggered by postcoital bleeding. Cancers of the vagina or fallopian tubes are rare causes of hemorrhage. # Uterine fibroids represent a common, benign condition that may lead to bleeding, specifically if the lesion affects the uterine cavity. # Polyps of the uterine lining are a common cause of bleeding, but such bleeding tends to be light.

Trauma

Sexual assault Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which ...

and rape can lead to injury and gynecological hemorrhage. # Accidents to the lower abdomen may lead to internal or external bleeding.

Bleeding disorder

Women with a bleeding disorder may be prone to more excessive bleeding. A hematologic work-up should discover the cause.

Other

On occasion an ovarian cyst can rupture and give rise to internal hemorrhage. This may occur during ovulation or as a result of

endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, f ...

. If the pregnancy test is positive, consider pregnancy related bleeding (see

), including

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...

and

ectopic pregnancy Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...

Diagnosis

A history will establish if the condition is acute or chronic, and if external circumstances are involved. A gynecologic examination is usually complemented by a gynecologic ultrasonography. A blood count determines the degree of anemia and may point out bleeding problems. The pregnancy test is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal. Diagnosis is broadly classified into supportive and definitive investigations:

Supportive

# Complete blood count to assess degree of anemia. # Ultrasonography to rule out uterine lesions, PID.

Definitive

# Pregnancy test for those who are not yet post menopausal mandatory. # Speculum examination to take samples for pap smear. # Dilation and curettage to get samples for histology and also control the bleeding if associated with abortion. # Colposcopy.

Definition

Menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...

occurs typically monthly, lasts 3–7 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from a

or an

, while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage.

First aid

Gynecologic hemorrhage needs to be evaluated as soon as possible by a physician. The amount and duration of bleeding will dictate whether a bleeding event is an emergency event.

Treatment

Treatment depends on diagnosis and may include hormonal therapy, iv fluids, blood transfusion, and/or a dilation and curettage. Internal bleeding requires laparoscopy or abdominal surgery, in rare and extreme cases a

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

is performed.

References

{{DEFAULTSORT:Gynecologic Hemorrhage Gynaecologic disorders Medical emergencies