Summary![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Vaginal bleeding that is not attributable to expected menstrual bleeding can be a clinical feature of a number of genitourinary conditions that affect not only the vagina but also the uterus, ovarian tubes, ovaries, and urethra. There are various causes of abnormal vaginal bleeding, and workup is determined by the patient's age and pregnancy status. Pain is an important differentiating feature that can further narrow down the differential diagnosis of abnormal vaginal bleeding.
For more information about physiological menstrual bleeding and abnormal uterine bleeding, see “The menstrual cycle and menstrual cycle abnormalities”. For more information on vaginal bleeding in pregnancy, see “Differential diagnosis of antepartum bleeding”.
Overview![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Overview of causes of vaginal bleeding in different age groups | |
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Age group | Causes |
Premenarchal children |
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Nonpregnant women |
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Pregnant women | |
Postmenopausal women |
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Painful vaginal bleeding![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Overview of differential diagnoses of painful vaginal bleeding [1] | |||||
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Differential diagnosis | Clinical features | Diagnostic findings | |||
Description of pain | Other clinical features | ||||
Ectopic pregnancy |
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Spontaneous abortion |
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Benign neoplasms | Adenomyosis |
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Uterine leiomyoma |
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Ovarian cyst rupture |
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Infection/inflammation | Pelvic inflammatory disease |
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Cervicitis |
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Trauma (e.g., foreign body, sexual abuse) |
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Painless vaginal bleeding![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Overview of differential diagnoses of painless vaginal bleeding [1] | |||
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Differential diagnosis | Clinical features | Diagnostic findings | |
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Malignant neoplasms | Cervical cancer |
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Endometrial cancer |
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Adverse effects (resulting from, e.g., anticoagulants, oral contraceptives, intrauterine devices) |
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Anembryonic pregnancy [2] |
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