Gynecologic hemorrhage overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Gynecologic hemorrhage represents excessive bleeding of the female reproductive system. Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or during delivery is an obstetrical hemorrhage.
Menstruation occurs typically monthly, lasts 3-7 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from a miscarriage or an ectopic pregnancy, while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage.
Diagnosis
History and Symptoms
A history will establish if gynecologic hemorrhage is acute or chronic, and if external circumstances are involved.
Laboratory Findings
A blood count determines the degree of anemia and may point out bleeding problems. The pregnancy test is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal.
Ultrasound
A physical examination is usually complemented by a gynecologic ultrasonography to find out the cause of gynecologic hemorrhage.
Treatment
Medical Therapy
Gynecologic hemorrhage needs to be evaluated as soon as possible by a physician. The amount and duration of bleeding will dictate whether a bleeding event is an emergency event. Treatment depends on diagnosis and may include hormonal therapy, IV fluids and/ or blood transfusion.
Surgery
Treatment of gynecologic hemorrhage depends on diagnosis and may include a dilation and curettage. Internal bleeding requires laparoscopy or abdominal surgery.
Primary Prevention
Generally gynecologic hemorrhage does not arise out of nowhere. Regular gynecologic examinations, cancer screening, and contraceptive measures go a long way in preventing and forestalling unsuspected acute bleeding events.