Gynecologic hemorrhage
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{{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]]