Unscheduled vaginal bleeding

Unscheduled vaginal bleeding

Unscheduled vaginal bleeding is defined as bleeding which occurs outside the normal menstrual period (non menstrual) or the regular withdrawal bleed associated with the combined oral contraceptive pill (1).

• unscheduled vaginal bleeding is included in the umbrella term "abnormal uterine bleeding (AUB)" under irregular non menstrual bleeding
  
  
• unscheduled bleeding includes intermenstrual bleeding (IMB) as well as post-coital bleeding (PCB)
  • IMB and PCB are not diagnoses but symptoms that require further assessment
  • differentiating the two conditions is difficult since they often occur together
  • both conditions should be taken into consideration when evaluating a woman with unscheduled bleeding
  • irregular bleeding seen with the use of hormonal contraception is generally known as breakthrough bleeding
    
    
• this symptom may be seen together with other menstrual disorders, such as heavy menstrual bleeding (when caused by fibroids or endometrial polyps) or heavy menstrual bleeding of unknown cause (formally called dysfunctional bleeding) (1,2)

Unscheduled vaginal bleeding often results in anxiety and concern due to its association with gynaecological cancer, particularly cervical and endometrial cancer (1)

Several causes for unscheduled bleeding have been described, out if which, some may cause intermenstrual bleeding predominantly while others result in post-coital bleeding, although there is a considerable overlap (1).

• causes usually differ with age;
  • in young women (<35 years), usually caused by contraceptive use, particularly progestogen only contraception while malignant disease is uncommon
  • in older women, the likelihood of cervical or endometrial cancer is high, as do other diseases such as uterine fibroids and polyps (1)

Reference:

1. Lumsden MA, Gebbie A, Holland C. Managing unscheduled bleeding in non-pregnant premenopausal women. BMJ. 2013;346:f3251.
2. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 2015. Investigation of intermenstrual and postcoital bleeding