DISCOVER THE MOST FREQUENT
CAUSE OF VAGINAL BLEEDING

Laila Nuranna

Division of Oncology Gynecology, Department of Obstetrics and Gynecology
Faculty of Medicine, University of Indonesia

Abstract
This topic shows the various causes of vaginal bleeding, and how common these diseases or conditions are in the general population. This is not a direct indication as to how commonly these diseases are the actual cause of Vaginal bleeding, but gives a relative idea as to how frequent these diseases are seen overall
Bleeding from the vagina may be abnormal when menstrual periods are too heavy or too light, last too long, occur too frequently, or are irregular. Any vaginal bleeding that occurs before puberty or after menopause is abnormal. Some causes are more common among certain age groups.
In children, vaginal bleeding is rare. The most common cause is injury to the vulva or vagina (sometimes due to insertion of an object, such as a toy), bleeding in children may also result from puberty that starts very early (precocious puberty).
In reproductive age, vaginal bleeding may be caused by birth control methods, such as oral contraceptives (a combination of a progestin and estrogen or a progestin alone) or an intrauterine device (IUD). Abnormal bleeding may also be caused by complications of pregnancy, such as an ectopic pregnancy, or by infections of the uterus, usually after delivery of a baby or an abortion. Other causes of bleeding include blood disorders involving abnormal clotting (such as leukemia or a low platelet count), a hydatidiform mole, endometriosis, and noncancerous growths (such as adenomyosis, fibroids, cysts, and polyps). Cancer may cause bleeding in women of reproductive age. Bleeding from the vulva is usually due to injury. Thyroid disorders can cause menstrual periods to be irregular.
In postmenopausal women, vaginal bleeding may be due to atrophic vaginitis, thinning or thickening (hyperplasia) of the lining of the uterus, or polyps in the uterus. Cancer, such as cancer of the cervix, vagina, or endometrial can also cause bleeding and should be excluded by proper diagnosis procedure.
By knowing the most frequent cause of vaginal bleeding gives a relative idea as to how frequent these diseases are seen overall, and then more important is to develop appropriate diagnosis. How to diagnose? Identify the age, the type of bleeding, during pregnant or not, is there any organ abnormality or related with hormonal imbalance.
Further procedure may support the diagnosis, identify the symptoms and the results of a physical examination (including a pelvic examination). And additional procedures may be needed. Procedures may include a Papanicolaou (Pap) test, a biopsy of the cervix, and dilation and curettage (D and C). Ultrasonography using an ultrasound device inserted through the vagina into the uterus (transvaginal ultrasonography) can determine whether the uterine lining is thickened. A biopsy of cells obtained during dilation and curettage can determine if the thickening is due to cancer.