Evaluation of vaginal bleeding

Classification

Abnormal vaginal bleeding is classified by age and gravidity:

• Before menarche

• During reproductive years: non-pregnant

• During reproductive years: pregnant

• Postmenopausal.

Disorders of menstrual bleeding, including intermenstrual bleeding, are discussed in the topic ‘Evaluation of abnormal uterine bleeding.

Epidemiology

Vaginal bleeding before menarche is uncommon and is most often caused by trauma.[1]Söderström HF, Carlsson A, Börjesson A, et al. Vaginal bleeding in prepubertal girls: etiology and clinical management. J Pediatr Adolesc Gynecol. 2016 Jun;29(3):280-5. http://www.ncbi.nlm.nih.gov/pubmed/26506030?tool=bestpractice.com

Prevalence estimates for postcoital bleeding vary from 0.7% to 9% among women of reproductive age.[2]Lindner LE, Geerling S, Nettum JA, et al. Clinical characteristics of women with chlamydial cervicitis. J Reprod Med. 1988 Aug;33(8):684-90. http://www.ncbi.nlm.nih.gov/pubmed/3050073?tool=bestpractice.com [3]Shapley M, Jordan K, Croft PR. An epidemiological survey of symptoms of menstrual loss in the community. Br J Gen Pract. 2004 May;54(502):359-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1266170 http://www.ncbi.nlm.nih.gov/pubmed/15113519?tool=bestpractice.com [4]Viikki M, Pukkala E, Hakama M. Bleeding symptoms and subsequent risk of gynecological and other cancers. Acta Obstet Gynecol Scand. 1998 May;77(5):564-9. http://www.ncbi.nlm.nih.gov/pubmed/9654181?tool=bestpractice.com Incidence is highest among patients aged 26 to 30 years.[5]Cohen O, Schejter E, Agizim R, et al. Postcoital bleeding is a predictor for cervical dysplasia. PLoS One. 2019 May 23;14(5):e0217396. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532898 http://www.ncbi.nlm.nih.gov/pubmed/31120980?tool=bestpractice.com  

Bleeding during early pregnancy is common, affecting 25% of women during the first trimester.[6]Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. BMJ. 1997 Jul 5;315(7099):32-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127042 http://www.ncbi.nlm.nih.gov/pubmed/9233324?tool=bestpractice.com [7]Hasan R, Baird DD, Herring AH, et al. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol. 2009 Oct;114(4):860-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828396 http://www.ncbi.nlm.nih.gov/pubmed/19888046?tool=bestpractice.com

Up to 11% of women report postmenopausal bleeding, with highest rates in the first year after the menopause.[8]Astrup K, Olivarius Nde F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004 Feb;83(2):203-7. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.0001-6349.2004.00400.x http://www.ncbi.nlm.nih.gov/pubmed/14756741?tool=bestpractice.com