Normal menstruation

Monthly vaginal bleeding is a condition expected in normal women in reproductive age, menstruation, and suggests the failure of the reproductive event; that is, that there is no pregnancy. 

Most of the causes of genital bleeding are benign and functional origin, they do not require expensive procedures or invasive and usually the etiology is quickly evident.

For more information about the menstrual cycle and female physiology visit my article on menstrual physiology.

Abnormal uterine bleeding

Submucosal and intramural myomas

  Improves partially through the use of hormonal contraceptives and tends to get worse over time if they grow into the endometrial cavity. May require open surgery (myomectomy) or minimally invasive surgical Hysteroscopy in the operating room by (using resectoscope, an energised device specially designed for intrauterine surgery)

Endometrial polyposis

   Many times they are asymptomatic and are discovered by chance during the pelvic ultrasound of routine study. Occasionally they generate breakthrough genital bleeding (metrorrhagia) or make regular bleeding more abundant (hipermenorrea).

  In young women can watch (if asymptomatic) that described a 25% spontaneous regression; in post menopausal women should always be eliminated.  

Endometrial hyperplasia

Endometrial glandular growth disordered, endometrial hyperplasia, is considered a progressive premalignant condition preceding (8-29% of the cases) to the emergence of an endometrial cancer in months or years.  

The finding is casual during routine gynecological control and less commonly by bleeding abnormal genital. The suspicion is always good counselor

Endometrial cancer

The malignant lesion of endometrial almost always arises in postmenopausal women and as potential background has the same risk factors of endometrial hyperplasia and endometrial polyps and diagnosis of endometrial hyperplasia.

Overall prognosis is good and their diagnosis is based on the endometrial biopsy by Hysteroscopic direct view or endometrial cannula. Treatment can be a simple hysterectomy without adjuvant for cancer, in early cases, up to a full Protocol for gynaecological cancer in advanced cases.

All postmenopausal patient with genital bleeding have endometrial cancer up to unless otherwise proven.

This principle, known from our stage of undergraduate students has saved thousands of women.

Infectious endometritis and autoimmune

Endometrial inflammation by infectious agents relates to spotted genital irregular and discreet. Diagnosis can be difficult and can be achieved by endometrial biopsy guided by Hysteroscopy and crop or specialized bacteriological studies (bacterial PCR) of the sample.

Autoimmune inflammation of the endometrium is a diagnosis of exclusion in the absence of other obvious cause.   It can cause irregular menstrual cycles of stained discreet and infertility or early loss of pregnancy in a recurrent manner.

Forgetfulness of one or more birth control pills

This is one of the most frequent causes of irregular bleeding. 

Abortion and ectopic pregnancy

The cardinal sign of abortion is genital bleeding (with or without belly pain) in a pregnant woman before the 20th week of pregnancy.

All reproductive-age women are pregnant until unless otherwise proven.

Pregnancy outside the womb, ectopic pregnancy, may present with bleeding genital and create the false impression of being an abortion when pregnancy is actually located in the fallopian tube and your break will lead to internal bleeding.

Every pregnant woman may have an ectopic pregnancy until unless otherwise proven.