Vaginal bleeding in the context of Menstruation

Miscarriage, also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can survive independently. Miscarriage before 6 weeks of gestation is defined as biochemical loss by ESHRE. Once ultrasound or histological evidence shows that a pregnancy has existed, the term used is clinical miscarriage, which can be "early" (before 12 weeks) or "late" (between 12 and 21 weeks). Spontaneous fetal termination after 20 weeks of gestation is known as a stillbirth. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation.

The most common symptom of a miscarriage is vaginal bleeding, with or without pain. Tissue and clot-like material may leave the uterus and pass through and out of the vagina. Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use. About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of cases involves chromosomal abnormalities. Diagnosis of a miscarriage may involve checking to see if the cervix is open or sealed, testing blood levels of human chorionic gonadotropin (hCG), and an ultrasound. Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding.

Cervical cancer is a type of cancer that develops in the cervix or in any layer of the wall of the cervix. It is due to the abnormal growth of cells that can invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

Virtually all cervical cancer cases (99%) are linked to genital human papillomavirus infection (HPV); most who have had HPV infections, however, do not develop cervical cancer. HPV 16 and 18 strains are responsible for approximately 70% of cervical cancer cases globally and nearly 50% of high-grade cervical pre-cancers. Minor risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners. Genetic factors also contribute to cervical cancer risk. Cervical cancer typically develops from precancerous changes called cervical intraepithelial neoplasia over 10 to 20 years. About 75% of cervical cancers are squamous cell carcinomas, 20-25% are adenocarcinoma, 3% are adenosquamous carcinomas, and less than 1% are small cell neuroendocrine tumors of the cervix. Diagnosis is typically by cervical screening followed by a biopsy. Medical imaging is then done to determine whether or not the cancer has spread beyond the cervix.

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. This complication has also been referred to as an extrauterine pregnancy (a.k.a. EUP). Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

Overall, ectopic pregnancies annually affect less than 2% of pregnancies worldwide. Risk factors for ectopic pregnancy include pelvic inflammatory disease, often due to chlamydia infection; tobacco smoking; endometriosis; prior tubal surgery; a history of infertility; and the use of assisted reproductive technology. Those who have previously had an ectopic pregnancy are at much higher risk of having another one. Most ectopic pregnancies (90%) occur in the fallopian tube, which are known as tubal pregnancies, but implantation can also occur on the cervix, ovaries, caesarean scar, or within the abdomen. Detection of ectopic pregnancy is typically by blood tests for human chorionic gonadotropin (hCG) and ultrasound. This may require testing on more than one occasion. Other causes of similar symptoms include: miscarriage, ovarian torsion, and acute appendicitis.

Abnormal uterine bleeding is vaginal bleeding from the uterus that is abnormally frequent, lasts excessively long, is heavier than normal, or is irregular. The term "dysfunctional uterine bleeding" was used when no underlying cause was present. Quality of life may be negatively affected.

The underlying causes may be structural or non-structural and are classified in accordance with the FIGO system 1 & 2. Common causes include: Ovulation problems, fibroids, the lining of the uterus growing into the uterine wall, uterine polyps, underlying bleeding problems, side effects from birth control, or cancer. Susceptibility to each cause is often dependent on an individual's stage in life (prepubescent, premenopausal, postmenopausal). More than one category of causes may apply in an individual case. The first step in work-up is to rule out a tumor or pregnancy. Vaginal bleeding during pregnancy may be abnormal in certain circumstances. Please see Obstetrical bleeding and early pregnancy bleeding for more information. Medical imaging or hysteroscopy may help with the diagnosis.

Irregular menstruation is a menstrual disorder whose manifestations include irregular cycle lengths as well as metrorrhagia (vaginal bleeding between expected periods). The possible causes of irregular menstruation may vary. The common factors of it are related to lifestyle, such as stress, body weight, and smoking status. Several studies indicate that COVID-19 vaccine of any type may disrupt the menstrual cycle, although only momentarily. This side effect should resolve on its own in the following month.

Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that can invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.

Approximately 40% of cases are related to obesity. Endometrial cancer is also associated with excessive estrogen exposure, high blood pressure and diabetes. Whereas taking estrogen alone increases the risk of endometrial cancer, taking both estrogen and a progestogen in combination, as in most birth control pills, decreases the risk. Between two and five percent of cases are related to genes inherited from the parents. Endometrial cancer is sometimes called "uterine cancer", although it is distinct from other forms of cancer of the uterus such as cervical cancer, uterine sarcoma, and trophoblastic disease. The most frequent type of endometrial cancer is endometrioid carcinoma, which accounts for more than 80% of cases. Endometrial cancer is commonly diagnosed by endometrial biopsy or by taking samples during a procedure known as dilation and curettage. A pap smear is not typically sufficient to show endometrial cancer. Regular screening in those at normal risk is not called for.