Gynecologic hemorrhage represents excessivebleeding of thefemale reproductive system.[1][2] Such bleeding could be visible or external, namely bleeding from thevagina, or it could be internal into the pelvic cavity or form ahematoma. Normalmenstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with apregnant state or duringdelivery is anobstetrical hemorrhage.
Causes of gynecologic bleeding include:[5]
Anovulation is a common cause of gynecological hemorrhage. Under the influence ofestrogen theendometrium (uterine lining) is stimulated and eventually such lining will be shed off (estrogen breakthrough bleeding). The anovulation chapter discusses its multiple possible causes. Longstanding anovulation can also lead toendometrial hyperplasia and facilitate the development of endometrial cancer.
Women with a bleeding disorder may be prone to more excessive bleeding. A hematologic work-up should discover the cause.
On occasion an ovarian cyst can rupture and give rise to internal hemorrhage. This may occur duringovulation or as a result ofendometriosis.
If thepregnancy test is positive, considerpregnancy related bleeding (seeobstetrical hemorrhage), includingmiscarriage andectopic pregnancy.
A history will establish if the condition is acute or chronic, and if external circumstances are involved. A gynecologic examination is usually complemented by agynecologic ultrasonography. A blood count determines the degree ofanemia and may point out bleeding problems. Thepregnancy test is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal.Diagnosis is broadly classified into supportive and definitive investigations:
Menstruation occurs typically monthly, lasts 3–7 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from amiscarriage or anectopic pregnancy, while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage.
Gynecologic hemorrhage needs to be evaluated as soon as possible by a physician. The amount and duration of bleeding will dictate whether a bleeding event is an emergency event.
Treatment depends on diagnosis and may include hormonal therapy, IV fluids,blood transfusion, and/or adilation and curettage. Internal bleeding requireslaparoscopy or abdominal surgery, in rare and extreme cases ahysterectomy is performed.
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