Metrorrhagia: Causes

Pathogenesis (development of disease)

In metrorrhagia, bleeding is outside of menstruation proper; it is usually prolonged and increased, and a regular cycle is not apparent (continuous bleeding). The cause is usually a cycle abnormality (cycle irregularity) or various diseases affecting the uterus (womb).

Etiology (causes)

Biographic causes

  • Hormonal factors
    • Pregnancy
    • Perimenopause – transitional period between premenopause and postmenopause; varying lengths of years before menopause (approximately five years) and after menopause (1 year).

Causes related to disease

Neoplasms – tumor diseases (C00-D48).

  • Cervical or portiocarcinoma (cancer of the cervix or uterine orifice, respectively).
  • Endometrial carcinoma (cancer of the uterus).
  • Tubal carcinoma (fallopian tube cancer)
  • Vaginal carcinoma (cancer of the vagina)

Pregnancy, childbirth and puerperium (O00-O99)

  • Abortion – premature termination of pregnancy with a birth weight of the embryo or fetus, respectively, of less than 500 g designated.
  • Abortive egg (wind egg) – placenta (placenta) develops, but not the embryo (trophoblast/outer cell layer of a blastocyst and connects it to the uterine wall conditionally capable of development; embryoblast/ pluripotent stem cells located inside the blastocyst from which the embryo develops perishes prematurely)
  • Bladder mole – malformation of the placenta (placenta).
  • Bleeding in early pregnancy (1st trimester/third trimester; about 20% of all pregnancies).
  • Extrauterine pregnancy – implantation of the fertilized egg outside the uterus (womb) such as: Tubargravidity (tubal pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity / abdominalgravidity (abdominal pregnancy) or cervicalgravidity (a pregnancy in the cervix).
  • Nidational bleeding – bleeding occurring at the time of implantation of the fertilized egg in the uterus.

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Atrophic colpitis (colpitis senilis; dry vagina) – due to the cessation of hormone production (estrogens).
  • Cervicitis (inflammation of the cervix).
  • Cervical polyp (cervical polyp).
  • Endometritis (inflammation of the uterus)
  • Glandular-cystic hyperplasia of the endometrium – pathological thickening of the endometrium due to increased estrogen action (eg, follicular persistence).
  • Contact bleeding of an ectopic – bleeding after intercourse from an ectopic (easily injured cylindrical epithelium on the cervical surface).
  • Myoma uteri (synonym: uterus myomatosus) – enlargement of the uterus due to the presence of one or more myoma nodules (benign muscular growths).
  • Ovulation bleeding (harmless bleeding after ovulation, caused by estrogen drop shortly after ovulation).
  • Spotting after menopause
  • Spotting while taking ovulation inhibitors (hormonal contraception; birth control pills).
  • Disruption of follicle maturation with so-called breakthrough bleeding.
  • Injured vessel of the vagina (vagina) or the portio (cervix), usually as spotting – for example, after sexual intercourse.

Medication