From the Guidelines
Vaginal bleeding can be caused by a variety of factors, including normal and abnormal causes, such as hormonal imbalances, structural issues, infections, and certain medications, and it is essential to seek medical attention promptly if experiencing unexpected vaginal bleeding, especially if heavy, persistent, or accompanied by pain, fever, or occurring after menopause. The causes of vaginal bleeding can be categorized into normal and abnormal causes. Normal causes include:
- Menstruation
- Implantation bleeding during early pregnancy
- Postpartum bleeding after childbirth Abnormal causes may include:
- Hormonal imbalances
- Structural issues like polyps or fibroids
- Infections such as cervicitis or pelvic inflammatory disease
- Certain medications like hormonal contraceptives More serious causes include:
- Ectopic pregnancy
- Miscarriage
- Cervical or uterine cancer
- Complications during pregnancy like placenta previa Trauma to the vaginal area, certain sexually transmitted infections, and perimenopause or menopause can also trigger bleeding. According to the most recent study 1, the outcome of pregnancies with vaginal bleeding in the second and third trimesters depends on the precise etiology for the bleeding, and imaging, particularly ultrasound (US), is the backbone of current medical practice. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel, and they recommend ultrasound (US) as the primary imaging modality in evaluation of patients with vaginal bleeding 1. It is crucial to determine the underlying cause of vaginal bleeding to recommend appropriate treatment, and a healthcare provider can perform appropriate examinations and tests to determine the cause. In cases where the cause of vaginal bleeding is not identifiable, it is essential to consider an underlying gynecological problem, such as interactions with other medications, an STD, pregnancy, or new pathologic uterine conditions (such as fibroids or polyps), and treat the condition or refer for care 1. The timing, amount, and accompanying symptoms help determine the cause of vaginal bleeding, and it is vital to seek medical attention promptly if experiencing unexpected vaginal bleeding, especially if heavy, persistent, or accompanied by pain, fever, or occurring after menopause.
From the FDA Drug Label
Clinical surveillance of all women using estrogen plus progestin therapy is important Adequate diagnostic measures, including directed or random endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal genital bleeding.
The cause of vaginal bleeding is not explicitly stated in the provided text, but it is mentioned that abnormal genital bleeding can be a sign of malignancy, such as endometrial cancer, and that estrogen plus progestin therapy may increase the risk of endometrial hyperplasia, which can be a precursor to endometrial cancer. However, the text does not provide a direct answer to the question of what causes vaginal bleeding. 2
From the Research
Causes of Vaginal Bleeding
- Structural causes: polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia 3
- Nonstructural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not otherwise classified 3, 4
- Systemic medical diseases: hematologic disorders, endocrine disease, renal insufficiency, hepatic abnormalities, and vasculitis 5
- Extragenital disorders: diseases of the thyroid gland, uncorrected diabetes, obesity, blood coagulation disorders, infectious diseases, and certain drugs 6
- Anovulatory, ovulatory, and structural causes 7
Classification of Causes
- The International Federation of Gynecology and Obstetrics classification system stratifies causes into structural and nonstructural categories 4
- The PALM-COEIN acronym facilitates classification, with PALM referring to structural etiologies and COEIN referring to nonstructural etiologies 3