P year‎ > ‎Obstetrics & Gynaecology‎ > ‎

13.06.06 Intermenstrual bleeding

Causes
  • Pregnancy-related
    • Ectopic pregnancy
    • Gestational trophoblastic disease
  • Physiological
    • 1-2% spot around ovulation
  • Iatrogenic
    • Combined oral contraceptive pill (COCP)
      • Either in too low dose or in combination with an enzyme-inducing drug
    • Progesterone-only pill
    • Contraceptive depot injections
    • Intrauterine systems (IUS) or implant
    • Emergency contraception
    • Tamoxifen
    • Following smear or treatment to the cervix
    • Caesarean section scars
    • Drugs altering clotting parameters
      • Anticoagulants, SSRIs, corticosteroids
    • Alternative remedies
      • Ginseng, ginkgo, soy supplements, St John's wort
  • Vaginal causes
    • Adenosis
    • Vaginitis 
      • Bleeding uncommon before the menopause
    • Tumours
  • Cervical causes
    • Infection 
      • Chlamydia, gonorrhoea
    • Cancer 
      • But bleeding is most often postcoital
    • Cervical polyps
    • Cervical ectropion
    • Condylomata acuminata (genital warts) of the cervix
  • Uterine causes
    • Endometrial polyps
    • Cancer 
      • Endometrial adenocarcinoma, adenosarcoma and leiomyosarcoma
    • Adenomyosis 
      • Usually only symptomatic in later reproductive years
    • Endometritis
    • Fibroids
  • Ovarian causes
    • Oestrogen-secreting ovarian cancers
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