Gynecologic hemorrhage 286371 213774824 2008-05-20T19:57:06Z Mizu onna sango15 5562443 /* See also */ {{Unreferenced|date=April 2007}} '''Gynecologic hemorrhage''' represents excessive bleeding of the [[female reproductive system]]. Such bleeding could be visible or external, namely bleeding from the [[vagina]], or it could be internal into the pelvic cavity or form a [[hematoma]]. Normal [[menstruation]] is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a [[pregnancy|pregnant]] state or during [[delivery]] is an [[obstetrical hemorrhage]]. ==Definition== [[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 a [[miscarriage]] or an [[ectopic pregnancy]], while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage. ==Causes== Causes of gynecologic bleeding include: ===Hormonal=== [[Anovulation]] is a common cause of gynecological hemorrhage. Under the influence of [[estrogen]] the [[endometrium]] (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 to [[endometrial hyperplasia]] and facilitate the development of endometrial cancer. ===Neoplasm=== #[[Cancer]] of the uterus is always a concern, specifically when the bleeding occurs after [[menopause]]. Other types of cancer include [[cervix|cervical cancer]]; bleeding in that case can sometimes be triggered by intercourse and is termed postcoital bleeding. Cancers of the vagina or fallopian tubes are rare causes of hemorrhage. #[[Uterine fibroids]] represent a common, benign condition that may lead to bleeding, specifically if the lesion affects the uterine cavity. #[[Endometrial polyp|Polyps]] of the uterine lining are a common cause of bleeding, but such bleeding tends to be light. ===Trauma=== # [[Sexual assault]] and rape can lead to injury and gynecological hemorrhage. # [[Accident]]s to the lower abdomen may lead to internal or external bleeding. ===Bleeding disorder=== Women with a bleeding disorder may be prone to more excessive bleeding. A hematologic work-up should discover the cause. ===Other=== On occasion an ovarian cyst can rupture and give rise to internal hemorrhage. This may occur during [[ovulation]] or as a result of [[endometriosis]]. If the [[pregnancy test]] is positive, consider [[pregnancy]] related bleeding (see [[obstetrical hemorrhage]]), including [[miscarriage]] and [[ectopic pregnancy]]. ==Diagnosis== A history will establish if the condition is acute or chronic, and if external circumstances are involved. A gynecologic examination is usually complemented by a [[gynecologic ultrasonography]]. A blood count determines the degree of [[anemia]] and may point out bleeding problems. The [[pregnancy test]] is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal. ==Prevention== Generally gynecologic hemorrhage does not arise out of nowhere. Regular gynecologic examinations, cancer screening, and contraceptive measures go a long way in preventing and forestalling unsuspected acute bleeding events. ==First aid== 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. ==Clinical treatment== Treatment depends on diagnosis and may include hormonal therapy, iv fluids, [[blood transfusion]], and/or a [[dilation and curettage]]. Internal bleeding requires [[laparoscopy]] or abdominal surgery. ==See also== *[[Medical emergency]] [[Category:Gynecology]] [[Category:Medical emergencies]]