women s health issues
Vaginal Bleeding
Evaluation of Vaginal Bleeding
Doctors first focus on determining whether the cause of vaginal bleeding is a serious or life-threatening disorder (such as a ruptured Ectopic Pregnancy ) and whether the bleeding is excessive, possibly resulting in shock. Doctors check for pregnancy in all women of childbearing age. In women with vaginal bleeding, certain characteristics are cause for concern: Excessive bleeding Loss of consciousness, weakness, light-headedness, cold and sweaty skin, difficulty breathing, and a weak and rapid pulse (which indicate Shock ) Bleeding that occurs before menstrual periods start (before puberty) or after they stop (after menopause) Bleeding during pregnancy In children, difficulty walking or sitting, bruises or tears around the genitals or anus or mouth, and/or vaginal discharge or itching (which may be signs of sexual abuse) Bleeding is considered excessive if any of the following occur: Women lose more than about a cup of blood. More than 1 pad or tampon is saturated per hour for a few hours. The blood contains large clots. Women with most warning signs should see a doctor immediately, as should those with large clots or clumps of tissue in the blood or with symptoms suggesting a bleeding disorder. Symptoms of a bleeding disorder include easy bruising, excessive bleeding during toothbrushing or after minor cuts, and rashes of tiny reddish purple dots or larger splotches (indicating bleeding in the skin). However, if the only warning sign is vaginal bleeding before puberty or after menopause, a delay of a week or so is not harmful. Women without warning signs should schedule a visit when practical, but a delay of several days is not likely to be harmful. If vaginal bleeding continues in newborns for more than a few days, or is heavy or foul smelling, they should be seen by a doctor. Doctors first ask the woman (or caregiver) questions about her symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the bleeding and the tests that may need to be done (see table Some Causes and Features of Vaginal Bleeding ). Doctors ask about the bleeding: How many pads or tampons are used per day or hour How long bleeding lasts When it started When it occurs in relation to menstrual periods and sexual activity They also ask about the woman's menstrual history: How old she was when menstrual periods started How long they last How heavy they are How long the interval between periods is Whether they are regular The woman is asked whether she has had previous episodes of abnormal bleeding, has had a disorder that can cause bleeding (such as a recent miscarriage), or takes birth control pills, other hormones, or other drugs that can cause excessive bleeding, (such as anticoagulants and nonsteroidal anti-inflammatory drugs (NSAIDs). The woman is asked about other symptoms, such as light-headedness, abdominal pain, and excessive bleeding after toothbrushing or a minor cut. The physical examination includes a Pelvic Examination . During the examination, doctors can identify disorders of the cervix, uterus, vagina, vulva, or urethra in women of all ages. In children, a general examination is done first to check for If no blood is present in the vagina, a rectal examination may be done to determine whether bleeding is coming from the digestive tract. If women are of childbearing age, doctors always do A urine or blood test for pregnancy If the urine pregnancy test is negative but doctors still suspect pregnancy, a blood test for pregnancy is done. It involves measuring a hormone produced by the placenta called human chorionic gonadotropin (hCG). The blood test is more accurate than the urine test when a pregnancy is very early (less than 5 weeks). Tests commonly done include Blood tests to measure thyroid hormone levels If bleeding has been heavy or lasted a long time, a complete blood cell count to check for anemia Other blood tests are done depending on the disorder doctors suspect. For example, if a bleeding disorder is suspected, the blood's ability to clot is assessed. If Polycystic Ovary Syndrome (PCOS) is suspected, blood tests to measure androgen hormone levels are done. Ultrasonography is often used to look for abnormalities in the reproductive organs if women have risk factors for endometrial cancer or if doctors suspect problems such as fibroids, polyps, or a tumor. For ultrasonography, a handheld ultrasound device is usually inserted into the vagina, but it may be placed on the abdomen. If ultrasonography detects thickening of the uterine lining (endometrial hyperplasia), hysteroscopy or sonohysterography may be done to look for small growths in the uterus. For Hysteroscopy , a viewing tube is inserted into the uterus through the vagina. For If results of these tests are abnormal or if they are inconclusive, doctors may take a sample of tissue from the lining of the uterus for analysis in the following circumstances: Women are over age 45. Women have risk factors for cancer of the reproductive tract, including cancers of the lining of the uterus (endometrial cancer) and ovaries. Too much estrogen is being produced, as occurs in women with Polycystic Ovary Syndrome (PCOS) or a high In postmenopausal women, the lining of the uterus (endometrium) is thickened (seen on an ultrasound). The sample may be obtained by suction (through a tube) or by scraping—a procedure called Dilation and Curettage (D and C). In postmenopausal women, the sample is usually obtained by hysteroscopy, which enables doctors to see inside the uterus and locate the abnormality. Other tests may be done, depending on which disorders seem possible. For example, a biopsy of the cervix may be done to check for cancer of the cervix. If abnormal bleeding does not result from any of the usual causes, it may be related to changes in the hormonal control of the menstrual cycle. 