Correspond to the bleeding bleeding occurs between periods.
We must distinguish bleeding that occur at puberty, those that occur during the reproductive years (including the pill) or after menopause, because the causes are often very different.
Any bleeding that occurs before puberty or after menopause should a priori be considered abnormal.
Metrorrhagia require rigorous analysis to rule out more serious causes before concluding that a simple hormone imbalance (functional metrorrhagia).
Vaginal bleeding that occur during menstruation, puberty, may be the discovery mode of a disorder of hemostasis, ie a hemorrhagic disease. This is a rare but serious that requires emergency care.
However, most often, the bleeding puberty is associated with excessive menstrual bleeding (menorrhagia) to form what are called dysfunctional uterine bleeding. It affects 2-5% of adolescents in the two years following menarche. They are due to cycles without ovulation, which is relatively common.In this case, the growth of the endometrium (lining of the = uterus) which occurred in the first part of the cycle under the effect of estrogen is not balanced in the second part of the cycle progesterone which explains the abundance of rules.
More menarche occurs earlier and regulate their cycles earlier. Thus half of cycles are ovulatory in the first year following the rules if they occurred at age 11, then it will take three years to reach this proportion of ovulatory cycles if menarche occurred at the age of 13.
Vaginal bleeding that occurs during genital activity is often associated with heavy menstrual bleeding (menorrhagia). Mechanisms depend obviously causes: pregnancy complicated infectious cause, cancer, cause uterine coagulation problems, etc..
The menorrhagia may also be due to atrophy (= loss) of the endometrium associated with stopping or skipping pills ostroprogestative, use of synthetic progestins or progestogens microdoses, a hormone replacement therapy menopause with excessive doses of progestins. In contrast, the bleeding may be due to hyperplasia (= excessive activity) of the endometrium in a hormone replacement therapy with progestin sequence too short.
Bleeding occurring after menopause must always be a balance, in particular to remove cancer of the endometrium (lining of the = uterus).
Before puberty, there may be a foreign body (toy, stones, etc..) That the girl is introduced into the vagina and stayed there. We must also think of trauma, search lesions of the vulva or vagina, evoke precocious puberty
At puberty, mention should be made of menorrhagia associated with hemorrhagic disease may be due to a deficiency of clotting factor (factor V, VII, VIII, X, von Willebrand disease) or a platelet disorder (eg Glanzmann disease ). It is generally moderate abnormality of hemostasis as severe abnormalities were found in childhood. But fortunately, most often (in 80% of cases) it is dysfunctional uterine bleeding.
We must also exclude sexual abuse. In adolescence, it is of course evoke a complication of pregnancy when there is genital activity. A dosage of beta-hCG (a blood test) will confirm or refute the diagnosis of pregnancy. The doctor will remove the particular diagnosis of miscarriage and ectopic pregnancy. Pain in the lower abdomen or vaginal discharge will guide to a genital infection. Age is more advanced and is easily think cancer. Of bleeding are also common when using an IUD. Acquired disorders of hemostasis should be dismissed and that the existence of a fibroid. If the balance is negative for other causes and that we are in the presence of progestogenic contraception then we will discuss dysfunctional uterine bleeding due to atrophy (= loss) of the endometrium.
After menopause, vaginal bleeding are afraid gynecological cancer (cancer of the endometrium represents 5% of cases of postmenopausal metrorrhagia) even if it is, thankfully, more often less severe injury (myoma, polyps, hyperplasia) which justifies and requires to further investigations. But bleeding can also, in about half the cases, be due to hormonal imbalance that is to say taking estrogen (stimulating the endometrium) or contrary to hormonal deficiency (causing atrophy of the endometrium)!
It must first ensure that the source of bleeding by pelvic examination shows that the bleeding from the cervix. Smears and endometrial biopsies are sometimes performed. A vaginal examination can sometimes enable the physician to identify an abnormal mass or an increase in uterine volume. The blood test can assess the extent of blood loss and anemia sometimes detect genuine.
Major bleeding requiring hospitalization and emergency assessment quickly to assess blood loss (Complete blood count, group Rh, antibody screening, coagulation).
A dosage of beta-hCG (a blood test) will ensure the absence of pregnancy.
An ultrasound is often performed in search of an organic lesion (= organ) or sometimes a MRI (magnetic resonance imaging).
Hysteroscopy (= introduction of an optical fiber by the cervix to see inside the body) is sometimes proposed.
Some also offer assessment by a blood glucose (diabetes?) And thyroid function (in more than one case hui, found hypothyroidism). Others suggest a more complete hormonal balance if we suspect a polycystic ovary syndrome.
In case of puberty dysfunctional uterine bleeding disorder linked to a high-dose estrogen combined with a progestin (or progestin combined with antifibrinolytic if cons-indication to estrogen) may be considered and possibly a contraceptive pill oestroprogestative dosed with normal.
The treatment of menorrhagia in childbearing obviously depends on their causes but when they are functional, they can opt for avoiding contraception and IUDs microprogestatifs copper. The levonorgestrel IUD seems to have good results.
Antifibrinolytic drugs or NSAIDs (nonsteroidal anti-inflammatory drugs) are sometimes offered with success.
Surgical treatments are also possible: hysterectomy (= removing the uterus) or myomectomy fibroid embolization, curettage and resection endo-uterine, endometrial (laser photocoagulation, thermocoagulation, electrocoagulation or electrosurgical).
Among the factors contributing to the occurrence of menorrhagia, there is excessive physical activity, alcohol, drugs, anorexia and bulimia.
Diabetes and thyroid conditions also favor anovulatory cycles and therefore, menometragies.
Vaginal bleeding are common in two or first three months of taking oral contraceptives and in case you forget a pill or when you decide to stop. They are also common with intrauterine devices (IUD).
In general, it is the most dosed contraceptive estrogens (and progestins) that cause more bleeding.
Progestogen contraception also increases the risk, but in this case, the addition of estrogen sometimes improves the situation. There will always eliminate an organic cause (= related injury) before criminalize contraception
Obstetrics and gynecology
Gynecology and obstetrics includes many disciplines, all dedicated to the health and well-being of women outside pregnancy (gynecology) or during pregnancy and childbirth (obstetrics).
This is a surgical specialty, but in France, some gynecologists are not active and do not delivery. In this case, they are called medical gynecologists.
Gynecology is divided into several branches. Obstetrics is monitoring the progress of pregnancy and childbirth.Gynecology itself is to the diagnosis and treatment of diseases of the genital and breast cancer (disease of the uterus, ovary, breast, sexually transmitted diseases), cancer screening gynecological smears and mammography in collaboration with radiologists, support the treatment of infertility, birth control (contraception or abortion) and the treatment of menopausal symptoms.
Senology, for breast disease is a specialty part gynecology. The pelvipérinéologie is a division of gynecologic surgery for the treatment of pelvic floor disorders.