Assessment of vaginal bleeding

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]Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand. 2003 May;82(5):405-22. http://www.ncbi.nlm.nih.gov/pubmed/12752071?tool=bestpractice.com

• 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]Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand. 2003 May;82(5):405-22. http://www.ncbi.nlm.nih.gov/pubmed/12752071?tool=bestpractice.com Rates of abnormal heavy vaginal bleeding in developing countries are unknown.[2]Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol. 2002 Feb;99(2):229-34. http://www.ncbi.nlm.nih.gov/pubmed/11814502?tool=bestpractice.com 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]Reid PC, Mukri F. Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3. BMJ. 2005 Apr 23;330(7497):938-9. http://www.bmj.com/cgi/content/full/330/7497/938 http://www.ncbi.nlm.nih.gov/pubmed/15695496?tool=bestpractice.com Incidence rates of premenarchal and postmenopausal bleeding are not known, although frequencies are higher in postmenopausal women who receive hormone replacement therapy (HRT).