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ULY CLINIC
ULY CLINIC
12 Septemba 2025, 00:27:27
Metrorrhagia
Metrorrhagia is defined as uterine bleeding that occurs irregularly between menstrual periods. The bleeding is usually light but can range from spotting to hemorrhage. While slight physiologic bleeding from the endometrium during ovulation is common, metrorrhagia can also indicate underlying gynecologic disorders, stress, drug effects, medical treatments, or intrauterine device use.
History and Physical Examination
Obtain a detailed menstrual history: age at menarche, duration of menstrual periods, interval between periods, and typical number of pads or tampons used.
Determine timing of metrorrhagia in relation to the menstrual cycle and associated symptoms.
Review last menstrual period and any recent changes in menstrual pattern.
Record history of previous gynecologic problems, contraceptive use, obstetric history, and prior gynecologic procedures.
Check dates of last Pap smear and pelvic examination, and inquire about sexual activity and protection.
Assess general health, emotional stress, and family pregnancy history. Ask about in utero exposure to diethylstilbestrol, which is linked to vaginal adenosis.
Perform a pelvic examination if indicated and obtain blood and urine samples for pregnancy testing.
Medical causes
Cause | Typical Presentation / History | Associated Findings |
Cervicitis | Nonspecific infection causing intermenstrual or posttraumatic bleeding | Red, granular, irregular lesions on cervix, purulent vaginal discharge (± odor), lower abdominal pain, fever |
Dysfunctional uterine bleeding | Abnormal bleeding not due to pregnancy or major gynecologic disorders | Scant or profuse, intermittent or constant bleeding |
Endometrial polyps | Usually intermenstrual or postmenopausal bleeding | Some patients asymptomatic; may cause spotting |
Endometriosis | Pre-menstrual metrorrhagia | Cyclical pelvic pain, dyspareunia, infertility, tender fixed adnexal mass |
Endometritis | Infection-related bleeding | Purulent vaginal discharge, enlarged uterus, fever, lower abdominal pain, abdominal muscle spasm |
Gynecologic cancer | Early cervical or uterine cancer | Later: pelvic pain, weight loss, fatigue, possible abdominal mass |
Uterine leiomyomas | Benign tumors | Metrorrhagia, abdominal heaviness, increasing girth, constipation, urinary frequency/urgency, possible pain if necrosis/torsion occurs |
Vaginal adenosis | Congenital or acquired | Roughening or nodules on vaginal mucosa, metrorrhagia |
Other causes
Drugs: Anticoagulants, oral, injectable, or implanted contraceptives.
Herbal remedies: Ginseng may cause postmenopausal bleeding.
Surgery/procedures: Cervical conization or cauterization.
Special considerations
Encourage bed rest to reduce bleeding.
Administer analgesics for discomfort.
Patient counseling
Explain all procedures, treatments, and warning signs requiring immediate medical attention.
Discuss the importance of regular gynecologic examinations and Pap smears for early detection of underlying conditions.
References
Brosens I, Benagiano G. Is neonatal uterine bleeding involved in the pathogenesis of endometriosis as a source of stem cells? Fertil Steril. 2013; doi:10.1016/j.fertnstert.2013.04.046
Brosens I, Gordts S, Benagiano G. Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod. 2013;28:2016–2031.