Abnormal Genital Tract Bleeding

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Abnormal Genital Tract Bleeding

Annekathryn Goodman, MD, Assistant Professor of Obstetrics, Gynecology,

Reproductive Biology, Harvard Medical School, Associate Director,

Division of Gynecologic Oncology, Massachusetts General Hospital,

Boston, Massachusetts.

[Clinical Cornerstone 3(1):25-35, 2000 © 2000 Excerpta Medica, Inc.]

Abstract

The etiology of abnormal genital tract bleeding encompasses a wide range

of disorders that can be secondary to anatomic changes of the female

genital tract, infection, endocrinologic disorders, malignancies, and

systemic illness. Appropriate workup is guided by age-related

differential diagnoses for abnormal bleeding. Modern diagnostic tools

can quickly focus the evaluation and allow timely intervention. Most

abnormal genital tract bleeding is uterine bleeding, which is one of the

most common gynecologic problems that health care providers will face.

It accounts for approximately 15% of office visits and 25% of

gynecologic operations. Abnormal uterine bleeding in reproductive-age

women is defined as bleeding at abnormal or unexpected times or by

excessive flow at the time of an expected menses. The average menstrual

cycle length and duration of

flow is 28 days and 4 days, respectively, with an average blood loss of

35cc.[1] Any bleeding should be considered abnormal in premenarchal

girls and in postmenopausal women except for those with predictable

withdrawal bleeding taking hormone replacement therapy. This article

will review the categories of abnormal genital tract bleeding and the

diagnostic tools needed to establish the correct diagnosis. Common

clinical cases will be presented to illustrate the presenting symptoms,

differential diagnoses, workup, treatment, and long-term follow-up.

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