Metrorrhagia(abnormal bleeding)

We must distinguish bleeding that occur at puberty, those that occur during the reproductive years (including the pill) or after menopause, because the causes are often very different.

Any bleeding that occurs before puberty or after menopause should a priori be considered abnormal.

Metrorrhagia require rigorous analysis to rule out more serious causes before concluding that a simple hormone imbalance (functional metrorrhagia). Metrorrhagia occurs due to hormone disorders or any other such irregularities. It could also be an indicator of some serious health issues such as endometriosis, cancer of reproductive organs or uterine fibroids. Read on more to find all about them.

Metrorrhagia usually is more commonly seen in the first few years of menarche. Abnormal bleeding occurring during this time is also known as Pubertal Metrorrhagia.

Metrorrhagia is also seen in females who are nearing menopause. In Metrorrhagia, uterine bleeding occurs in females outside of their normal dates of menstrual bleeding. This is mostly spotting but in some cases severe bleeding may also occur.

Causes
Some of the causes of Metrorrhagia are:

1.Endometrial Hyperplasia:
This is a condition which arises due to abnormally elevated levels of estrogen and decreased levels of progesterone.

2.Uterine Cancer:
Uterine cancer is seen mostly in aged females who have reached their menopausal phase and thus postmenopausal females are more vulnerable for uterine cancer resulting in Metrorrhagia. Ovarian cysts may also be one of the causes of Metrorrhagia.

3.Polyp Rupture:
This result in females who may not even be aware that they have cervical or endometrial polyps and hence do not seek treatment which results in the rupture of these polyps causing Metrorrhagia. The bleeding in such cases usually occurs after a sexual intercourse.

4.Cervicitis:
This condition is caused as a result of cervical infection. As a result of this infection, the female experiences Metrorrhagia.

5.Miscarriage/Abortion:
A female who has had a miscarriage or has undergone an abortion may also have Metrorrhagia. This may be due to certain fetal remnants which cause such abnormal bleeding.

6.Infectious Causes:
Metrorrhagia can also be caused due to unprotected sexual intercourse resulting in sexually transmitted diseases.

7.Hormonal Imbalance:
Hormonal imbalance such as those caused by thyroid disorders may also result in Metrorrhagia

8.Blood Clotting Abnormality:
Females who have high affinity to bleed and have coagulation problems are prone to have Metrorrhagia.

9.Contraception:
There are certain barrier methods of contraception which when used may cause an injury to the vagina or the lining of the uterus resulting in Metrorrhagia. Intrauterine Device or IUD is one such common contraceptive method which tends to cause Metrorrhagia.

Symptoms
Metrorrhagia symptoms are evident and the following symptoms may or may not be present:

1.Light to heavy bleeding between regular menstrual periods
2.Abdominal pain or cramps
3.In cases of miscarriage and ectopic pregnancy, severe abdominal cramps
Diagnosis
You should contact your doctor if you experience bleeding between periods or bleeding after you have completed menopause. Your doctor can examine you while you are bleeding. Do not delay an appointment because you are bleeding. It is helpful to keep a record of your periods and irregular bleeding to bring to your appointment.

Your doctor will review your medical history and symptoms. Your doctor will perform a physical examination. During your pelvic examination, cultures may be taken to test for infection or sexually transmitted disease. Blood tests may be used to test your thyroid and hormone levels. You may be tested for pregnancy. A Pap smear may be taken to check for cervical cancer.

Treatment
The treatment of Metrorrhagia begins as soon as a cause of the condition is identified. If the cause is more benign such as an infection or a sexually transmitted disease then the patient may be given medications to cure the condition and get relief from Metrorrhagia.

The patient will be asked to take complete bed rest until the causative factor is treated as the excessive blood loss may make the patient anemic which may have its inherent complications. In some cases where the patient has extremely heavy bleeding then the patient may be shifted to an inpatient setting for observation and treatment until the condition is completely treated.

Prevention
Females over the age of 18 or who are sexually active should receive annual Pap smear tests and pelvic examinations.

Complications
It is important to contact your doctor if you experience metrorrhagia. In some cases, it may be associated with a serious condition, such as cancer. Women that experience symptoms of miscarriage or ectopic pregnancy should contact their doctors immediately.

Specialty concern
Gynecology is divided into several branches. Obstetrics is monitoring the progress of pregnancy and childbirth.Gynecology itself is to the diagnosis and treatment of diseases of the genital and breast cancer (disease of the uterus, ovary, breast, sexually transmitted diseases), cancer screening gynecological smears and mammography in collaboration with radiologists, support the treatment of infertility, birth control (contraception or abortion) and the treatment of menopausal symptoms.

Senology, for breast disease is a specialty part gynecology. The pelvipérinéologie is a division of gynecologic surgery for the treatment of pelvic floor disorders.

Dr. Shivani Bhardwaj