Vaginal bleeding

Vaginal bleeding
Sonohysterography performed because of postmenopausal bleeding. In serial images, polyps would be more immobile than freely moving debris within the uterine cavity which are seen in the image.
Specialty	Gynecology

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix.^[1] Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Regular monthly vaginal bleeding during the reproductive years, menstruation, is a normal physiologic process. During the reproductive years, bleeding that is excessively heavy (menorrhagia or heavy menstrual bleeding), occurs between monthly menstrual periods (intermenstrual bleeding), occurs more frequently than every 21 days (abnormal uterine bleeding), occurs too infrequently (oligomenorrhea), or occurs after vaginal intercourse (postcoital bleeding) should be evaluated.^[2][3]

The causes of abnormal vaginal bleeding vary by age,^[4] and such bleeding can be a sign of specific medical conditions ranging from hormone imbalances or anovulation to malignancy (cervical cancer, vaginal cancer or uterine cancer).^[2] In young children, or elderly adults with cognitive impairment, the source of bleeding may not be obvious, and may be from the urinary tract (hematuria) or the rectum rather than the vagina, although most adult women can identify the site of bleeding.^[5] When vaginal bleeding occurs in prepubertal children or in postmenopausal women, it always needs medical attention.^[6][7][5]

Vaginal bleeding during pregnancy can be normal, especially in early pregnancy.^[8] However, bleeding may also indicate a pregnancy complication that needs to be medically addressed.^[8] During pregnancy bleeding is usually, but not always, related to the pregnancy itself.

The treatment of vaginal bleeding is dependent on the specific cause, which can often be determined through a thorough history, physical, and medical testing.^[9]