Metrorrhagia - Causes and Symptoms

Definition

Metrorrhagia is an abnormal uterine bleeding that occurs between two consecutive menstruation, or at a time when there should be no menstrual flows (before the menarche, during pregnancy and after menopause).

Unlike spotting, the extent of intermenstrual blood loss is abundant in the metrorrhagia. Furthermore, the metrorrhagia appears in a recurrent and protracted manner.

Metrorrhagia can be caused by hormonal imbalances in the hypothalamic-pituitary-gonadal axis (dysfunctional uterine bleeding), by gynecological diseases (tumors and inflammatory pathologies) or, less often, by coagulation abnormalities and systemic diseases (chronic liver diseases, renal insufficiency and thyroid dysfunction).

The most frequent cause, in women under 20 and over 45 years of age, is dysfunctional in nature and coincides with the lack of ovulation (anovulatory cycle) and with the consequent hormonal imbalance between estrogen and progesterone.

In the first post-menarcal period, on the other hand, metrorrhagia can be linked to irregular ovulation or blood dyscrasias (eg hemophilias, leukemia and thrombocytopenia of various kinds).

In adult women, metrorrhagia can also indicate the presence of endometrial hyperplasia and genital tumors, benign (fibroids, cervical and endometrial polyps) or malignant tumors (tubal neoplasia, uterus, cervix, vagina, endometrium and ovaries).

Pathological conditions associated with metrorrhagia include: endometriosis, endometritis, adenomyosis, polycystic ovary syndrome, pelvic inflammatory diseases and sexually transmitted infections.

Acute metrorrhagia can also result from extrauterine pregnancies, spontaneous abortion and untimely detachment of the placenta. Other causes are traumas (eg introduction of foreign bodies into the vagina or lesions of the cervix, vagina or vulva) and atrophic vaginitis. Sometimes, metrorrhagia is a consequence of the use of intrauterine devices and of anticoagulant or contraceptive drugs.