Metrorrhagia

Metrorrhagia (synonyms: Bleeding outside menstruation; Bleeding, acyclic; Bleeding abnormality – bleeding outside menstruation; Menstruation, acyclic; Acyclic bleeding; ICD-10-GM N92.1: Excessive or too frequent menstruation with irregular menstrual cycle: metrorrhagia) belongs to the type disorders. It is bleeding outside of menstruation proper; it is usually prolonged and increased, and a regular cycle is not evident.

Bleeding abnormalities (bleeding or cycle disorders) are divided into rhythm disorders and type disorders.

Type disorders include:

• Hypermenorrhea – bleeding is too heavy; usually the affected person uses more than five pads/tampons per day
• Hypomenorrhea – bleeding is too weak; the affected person consumes less than two pads per day
• Brachymenorrhea – bleeding duration < 3 days.
• Menorrhagia – bleeding is prolonged (> 7 days and < 14 days) and increased.
• Spotting (bleeding in between) such as:
  • Premenstrual spotting – spotting before the actual menstruation.
  • Postmenstrual spotting – spotting after the actual menstruation.
  • Middle bleeding – spotting at the time of ovulation (ovulation).
• Metrorrhagia – bleeding outside the actual menstruation; it is usually prolonged and increased, a regular cycle is not recognizable
• Menometrorrhagia – prolonged and increased menstrual bleeding (bleeding duration > 14 days) with intermenstrual bleeding (eg, juvenile menometrorrhagia; because of hypogonadism (“ovarian hypofunction”), hyperprolactinemia (increase in blood prolactin levels); often in menopause)Caveat: the term menometrorrhagia is often used synonymously with metrorrhagia in the clinic.

Metrorrhagia belongs to the acyclic bleeding.

Frequency peak: metrorrhagia often occurs in adolescence and during perimenopause (transitional phase between premenopause and postmenopause; different length of years before menopause – about five years – and after menopause (1 year)).

Course and prognosis: Metrorrhagia often occurs in adolescence as juvenile menometrorrhagia (e.g. due to hypogonadism/”ovarian hypofunction”, hyperprolactinemia/pathological (pathological) elevation of prolactin levels) and during perimenopause (due to the development of ovarian insufficiency). If metrorrhagia occurs recurrently (recurring), gynecologic evaluation is required to determine whether cervical or cervical-mouth cancer or endometrial cancer is present.