aetiology
Last edited 09/2018
The following causes should be considered in assessment of intermenstrual bleeding:
- hormonal imbalance
- during perimnopausal period
- however bleeding in this group should be investigated since it can be a symptom of underlying endometrial cancer
- as a result of progesterone-only or low-dose oestrogen contraceptive pills
- underdosing with the combined contraceptive pill causing breakthrough
bleeding. Causes include:
- too low a prescription
- concurrent antiepileptic treatment
- diarrhoea
- underdosing with the combined contraceptive pill causing breakthrough
bleeding. Causes include:
- contraceptive injection e.g. depoprovera
- intrauterine contraceptive device
- anovulatory uterine bleeding
- non hormonal
- an ectropion which bleeds spontaneously or after intercourse
- cervical polyps or cancer
- fibroids
- submucosal or pedunculated fibroids lead to irregular or heavy bleeding
- endometrial polyps or cancer
- inflammatory endometrial response to a copper intrauterine device
- a malpositioned device (low lying or abnormally rotated in the uterine cavity) has a higher risk of irregular bleeding and pain
- infection
- endometritis caused by Chlamydia
- gonorrhoea - less prevalent than Chlamydia
- drugs which alter clotting parameters
- antipsychotics, corticosteroids and anticoagulants
- pregnancy related e.g. – ectopic pregnancy (1,2)
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