Assessment of vaginal bleeding

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Summary

Terminology and classification

Abnormal vaginal bleeding can be menstrual related (e.g., menorrhagia) or non-menstrual related (e.g., intermenstrual or postcoital bleeding). Clinical definitions related to this topic include: [1]

  • Menorrhagia: menstrual blood loss of >80 mL per cycle

  • Polymenorrhoea: menstruation more frequent than every 3 weeks

  • Metrorrhagia: abnormal uterine bleeding between menstrual periods

  • Premenarchal bleeding: vaginal bleeding that occurs before a girl is 9 years old

  • Postmenopausal bleeding: vaginal bleeding that occurs >12 months after menopause has been established.

One useful way of classifying abnormal vaginal bleeding is by age:

  • Before menarche (usual age of menarche is between 10 and 12 years)

  • During reproductive years

  • Postmenopausal.

Epidemiology

Abnormal vaginal bleeding occurs in up to one quarter of all women of reproductive age in the US. [1] Rates of abnormal heavy vaginal bleeding in non-Western countries are unknown. [2] Almost 25% of all gynaecological surgeries are due to abnormal uterine bleeding. In the UK, 20% of women have a hysterectomy by the age of 60 years, mainly for heavy bleeding, despite the fact that 40% have a normal uterus on histological examination. [3] Incidence rates of premenarchal and postmenopausal bleeding are not known, although frequencies are higher in postmenopausal women who receive hormone replacement therapy (HRT).

Differential diagnosis

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Last updated: May 14, 2013
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