Metrorrhagia

Metrorrhagia: Excerpt from Handbook of Signs & Symptoms (Third Edition)

Metrorrhagia — uterine bleeding that occurs irregularly between menstrual periods — is usually light, although it can range from staining to hemorrhage. Usually, this common sign reflects slight physiologic bleeding from the endometrium during ovulation. However, metrorrhagia may be the only indication of an underlying gynecologic disorder and can also result from stress, drugs, treatments, and intrauterine devices.

History and physical examination

Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating and about the duration of menstrual periods, the interval between them, and the average number of tampons or pads she uses. When does metrorrhagia usually occur in relation to her period? Does she experience other signs or symptoms? Find out the date of her last menses, and ask about other recent changes in her normal menstrual pattern. Get details of previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou smear and pelvic examination. Ask the patient when she last had sex and whether or not it was protected. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient’s mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)

Perform a pelvic examination if indicated, and obtain blood and urine samples for pregnancy testing.

Medical causes

Cervicitis

Cervicitis is a nonspecific infection that may cause spontaneous bleeding, spotting, or posttraumatic bleeding. Assessment reveals red, granular, irregular lesions on the external cervix. Purulent vaginal discharge (with or without odor), lower abdominal pain, and a fever may occur.

Dysfunctional uterine bleeding

Abnormal uterine bleeding not caused by pregnancy or major gynecologic disorders usually occurs as metrorrhagia, although menorrhagia is possible. Bleeding may be profuse or scant, intermittent or constant.

Endometrial polyps

In most patients, endometrial polyps cause abnormal bleeding, usually intermenstrual or postmenopausal; however, some patients do remain asymptomatic.

Endometriosis

Metrorrhagia (usually premenstrual) may be the only indication of endometriosis or it may accompany cyclical pelvic discomfort, infertility, and dyspareunia. A tender, fixed adnexal mass may be palpable on bimanual examination.

Endometritis

Endometritis causes metrorrhagia, purulent vaginal discharge, and enlargement of the uterus. It also produces a fever, lower abdominal pain, and abdominal muscle spasm.

Gynecologic cancer

Metrorrhagia is commonly an early sign of cervical or uterine cancer. Later, the patient may experience weight loss, pelvic pain, fatigue and, possibly, an abdominal mass.

Uterine leiomyomas

Besides metrorrhagia, uterine leiomyomas may cause increasing abdominal girth and heaviness in the abdomen, constipation, and urinary frequency or urgency. The patient may report pain if the uterus attempts to expel the tumor through contractions and if the tumors twist or necrose after circulatory occlusion or infection, but the patient with leiomyomas is usually asymptomatic.

Vaginal adenosis

Vaginal adenosis commonly produces metrorrhagia. Palpation reveals roughening or nodules in affected vaginal areas.

Other causes

Drugs

Anticoagulants and oral, injectable, or implanted contraceptives may cause metrorrhagia.

Herb Alert

Surgery and procedures

Cervical conization and cauterization may cause metrorrhagia.

Special considerations

Encourage bed rest to reduce bleeding. Give an analgesic for discomfort.

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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