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'''For patient information, click [[Gynecologic hemorrhage (patient information)|here]]'''
{{Gynecologic hemorrhage}}
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==Overview==
==[[Gynecologic hemorrhage overview|Overview]]==
'''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==
==[[Gynecologic hemorrhage pathophysiology|Pathophysiology]]==
[[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==
==[[Gynecologic hemorrhage causes|Causes]]==
Causes of gynecologic bleeding include:


===Hormonal===
==[[Gynecologic hemorrhage differential diagnosis|Differentiating Gynecologic hemorrhage from other Diseases]]==
[[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.
#[[Uterine polyp|Polyps]] of the uterine lining are a common cause of bleeding, but such bleeding tends to be light.


===Trauma===
==[[Gynecologic hemorrhage epidemiology and demographics|Epidemiology and Demographics]]==
# [[Sexual assault]] and rape can lead to injury and gynecological hemorrhage.
# [[Trauma]] to the lower abdomen may lead to internal or external bleeding.


===Bleeding disorder===
==[[Gynecologic hemorrhage risk factors|Risk Factors]]==
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]].
==[[Gynecologic hemorrhage natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==Diagnosis==
==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.
[[Gynecologic hemorrhage history and symptoms|History and Symptoms]] | [[Gynecologic hemorrhage physical examination|Physical Examination]] | [[Gynecologic hemorrhage laboratory findings|Laboratory Findings]] | [[Gynecologic hemorrhage CT|CT]] | [[Gynecologic hemorrhage ultrasound|Ultrasound]] | [[Gynecologic hemorrhage other imaging findings|Other Imaging Findings]] | [[Gynecologic hemorrhage other diagnostic studies|Other Diagnostic Studies]]


==Prevention==
==Treatment==
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.
[[Gynecologic hemorrhage medical therapy|Medical Therapy]] | [[Gynecologic hemorrhage primary prevention|Primary Prevention]] | [[Gynecologic hemorrhage cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Gynecologic hemorrhage future or investigational therapies|Future or Investigational Therapies]]


==First aid==
==Case Studies==
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.
[[Gynecologic hemorrhage case study one|Case #1]]
 
==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]]


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Latest revision as of 16:31, 12 February 2013

For patient information, click here

Gynecologic hemorrhage Microchapters

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Overview

Pathophysiology

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Differentiating Gynecologic hemorrhage from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

Ultrasound

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Medical Therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

Causes

Differentiating Gynecologic hemorrhage from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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