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
- 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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