Causes of abnormal uterine bleeding

We all know that the female body structure is particularly complex, and the uterus is a particularly important organ for women. We all know that uterine bleeding normally occurs during women's menstrual period every month, but there are often many times when the uterus also bleeds during non-menstrual period, but we often mistakenly think it is irregular menstruation. In fact, abnormal uterine bleeding must be taken seriously by us. It seriously affects our physical health. What causes abnormal uterine bleeding? Let us understand the causes of abnormal uterine bleeding.

Causes of abnormal uterine bleeding:

Newborn girls may have a few days of spotting because the endometrium is stimulated by placental estrogens while the fetus is in the womb. Any other genital tract bleeding during childhood is rare and should be sought. The most common causes are accidental trauma to the vulva and vagina. Vaginitis (often due to foreign bodies), urethral prolapse, and gynecological tumors can also cause bleeding. Ovarian tumors generally do not cause bleeding unless there is endocrine activity. Bleeding in childhood must be considered precocious puberty and can often be identified by the development of secondary sexual characteristics. In many cases, the cause of bleeding is unknown, but it may be due to medication, lesions of the central nervous system, hypothyroidism or adrenal glands, or ovarian tumors.

Eighty percent of vaginal adenosis and clear cell adenocarcinoma of the vagina and cervix present with bleeding and increased vaginal discharge. These lesions are associated with exposure to diethylstilbestrol in the womb and are diagnosed by smear and biopsy of the suspected area using a colposcope. Most lesions do not require treatment unless malignancy is present, but they should be checked regularly.

Reproductive Age During the reproductive years, primary or secondary blood disorders with coagulation abnormalities may cause abnormal bleeding. Adolescents and women suspected of having a coagulation disorder should undergo hematologic testing. For example, dysfunctional uterine bleeding is the most common symptom in women with von Willebrand disease.

The most common organic cause of abnormal bleeding in women of reproductive age is pregnancy complications. Almost half of women with bleeding have pregnancy symptoms or confirmed early pregnancy, and they will spontaneously miscarry the fetus. Important differential diagnoses include ectopic pregnancy (see Section 252) and gestational trophoblastic disease (see Section 241). Infection and endometritis with retention of products of conception often bleed shortly after delivery or abortion, but sometimes ≥ 2 weeks later.

Vulvar bleeding during the reproductive years is almost always due to trauma.

Vaginal lesions that cause bleeding include vaginal adenosis and malignancy. Bleeding from vaginitis is more common in children and postmenopausal women because their vaginal mucosa is thinner. However, if the inflammation is severe, it can also cause a small amount of spotting during reproductive years. Granulation tissue formed after surgery (especially hysterectomy) can cause bleeding. A biopsy may be required to rule out malignancy. Although cauterization or cryotherapy with silver nitrate can stop bleeding in most cases, large lesions may require surgical excision.

Cervical lesions that cause bleeding include cervical cancer, benign cervical lesions, cervicitis (rarely causes bleeding unless associated with cervical ectropion, but may cause bloody discharge), cervical or endometrial polyps (causing postcoital bleeding), submucosal fibroids (causing intermenstrual bleeding, menorrhagia, or frequent menstruation), and condyloma acuminatum of the cervix.

Adenomyosis (benign invasion of the endometrium into the myometrium) is a common disease that causes symptoms in only a minority of patients, often in the later reproductive years. Heavy menstrual bleeding and intermenstrual bleeding are the most common complaints, followed by pelvic pain and frequent urination and tenesmus. During gynecological examination, the uterus may be felt to be enlarged, round, slightly softer than normal, and may be accompanied by fibroids. MRI is performed before surgery to help make the diagnosis. If the diagnosis is correct, hysterectomy can relieve symptoms in all patients. Contraceptive steroids and GnRH analogs are not very effective.

40% of women aged 40 have fibroids, and only a few with symptoms require treatment. They can cause any type of bleeding.

Functional ovarian cysts are common, with >50% of patients experiencing menstrual abnormalities ranging from amenorrhea to menorrhagia. In young women, cystic adnexal masses may disappear spontaneously. Adnexal masses >5 cm and persisting for >1 month require surgical exploration to exclude tumor. Any ovarian tumor can cause uterine bleeding, but bleeding tends to occur only in tumors with endocrine activity.

Thyroid dysfunction may be associated with menstrual irregularities. It may cause menorrhagia, but more commonly it is oligomenorrhea and amenorrhea.

Postmenopausal women with uterine bleeding must be excluded from gynecological malignancies. The most common benign diseases that cause postmenopausal bleeding are atrophic vaginitis, atrophic endometrium, endometrial polyps, and endometrial hyperplasia. The cause of bleeding from atrophic endometrium is unclear. Endometrial polyps do not need to be treated after diagnostic curettage, but recurrence must be observed. Endometrial hyperplasia should be treated with progesterone therapy or hysterectomy.

We know the causes of abnormal uterine bleeding. In daily life, especially women must pay special attention to their health problems. There are many reasons for abnormal uterine bleeding. Some are caused by some diseases. Especially women must observe their leucorrhea and menstruation. Therefore, when our body shows abnormalities, we must treat it in time to avoid causing greater harm to us.