What is Metrorrhagia?
Metrorrhagia which is also known by the name of Dysfunctional Uterine Bleeding is a common pathological condition found in females of reproductive age. Metrorrhagia usually is more commonly seen in the first few years of menarche. Abnormal bleeding occurring during this time is also known as Pubertal Metrorrhagia.
Metrorrhagia is also seen in females who are nearing menopause. In Metrorrhagia, uterine bleeding occurs in females outside of their normal dates of menstrual bleeding. This is mostly spotting but in some cases severe bleeding may also occur.
The bleeding that occurs in Metrorrhagia is irregular in pattern meaning that the abnormal bleeding may occur any time in between the menstrual cycle of a female. This may occur due to an underlying medical condition that needs to be investigated and treated further.
Even though there may be numerous medical conditions that may cause Metrorrhagia but usually it is not a serious condition and once a cause is identified then treatment can be done successfully for Metrorrhagia. It is suggested to consult with an OB/GYN straight away whenever a female suspects an incidence of Metrorrhagia.
What are the Causes of Metrorrhagia?
As stated above, there can be numerous causes which can lead to Metrorrhagia. Some of the causes of Metrorrhagia are:
Endometrial Hyperplasia: This is a condition which arises due to abnormally elevated levels of estrogen and decreased levels of progesterone. This causes an irregularity and imbalance in the hormonal levels of the body resulting in Metrorrhagia.
Uterine Cancer: This is one of the most common causes of Metrorrhagia. Uterine cancer is seen mostly in aged females who have reached their menopausal phase and thus postmenopausal females are more vulnerable for uterine cancer resulting in Metrorrhagia. Ovarian cysts may also be one of the causes of Metrorrhagia.
Polyp Rupture: This result in females who may not even be aware that they have cervical or endometrial polyps and hence do not seek treatment which results in the rupture of these polyps causing Metrorrhagia. The bleeding in such cases usually occurs after a sexual intercourse.
Cervicitis: This condition is caused as a result of cervical infection. As a result of this infection, the female experiences Metrorrhagia. This condition requires prompt medical attention as this may progress on to a chronic condition and the infection may also spread.
Miscarriage/Abortion: A female who has had a miscarriage or has undergone an abortion may also have Metrorrhagia. This may be due to certain fetal remnants which cause such abnormal bleeding.
Infectious Causes: Metrorrhagia can also be caused due to unprotected sexual intercourse resulting in sexually transmitted diseases. Syphilis is a medical condition which is well known to cause Metrorrhagia. Females with a history of Lyme disease are also predisposed to frequent infections which may increases incidences of Metrorrhagia.
Hormonal Imbalance: Hormonal imbalance such as those caused by thyroid disorders may also result in Metrorrhagia
Blood Clotting Abnormality: Females who have high affinity to bleed and have coagulation problems are prone to have Metrorrhagia.
Contraception: There are certain barrier methods of contraception which when used may cause an injury to the vagina or the lining of the uterus resulting in Metrorrhagia. Intrauterine Device or IUD is one such common contraceptive method which tends to cause Metrorrhagia.
Diagnosis Of Metrorrhagia
As soon as the female presents to the OB/GYN for the complaint of Metrorrhagia, the diagnosis of the cause begins with a detailed history taking of the patient. During history taking the physician may ask the patient certain questions like whether there is a recent history of any miscarriage or abortions, is there any bleeding after a sexual intercourse, is the patient using any type of contraceptive device like an IUD, and also a detailed account of the patient’s menstrual cycle.
Once the physician has this information, then she may perform a pelvic examination and may also inspect the vagina to look for any infections of other abnormalities. This will help the physician identify any uterine problems.
Imaging studies in the form of a transvaginal sonography may be done to look for any abnormalities within the uterus and cervix such as a tumor which may be the cause of the patient’s Metrorrhagia. Finally, a Pap smear will be done to look for presence of any sexually transmitted diseases in the patient which may be causing the patient Metrorrhagia.
How is Metrorrhagia Treated?
The treatment of Metrorrhagia begins as soon as a cause of the condition is identified. If the cause is more benign such as an infection or a sexually transmitted disease then the patient may be given medications to cure the condition and get relief from Metrorrhagia.
The patient will be asked to take complete bed rest until the causative factor is treated as the excessive blood loss may make the patient anemic which may have its inherent complications. In some cases where the patient has extremely heavy bleeding then the patient may be shifted to an inpatient setting for observation and treatment until the condition is completely treated.
In cases where abortion or miscarriage is the cause of Metrorrhagia then a procedure called Dilatation and Curettage or D&C will be performed to clean the uterus and cervix of any remnant of the fetus from the body which may be causing Metrorrhagia.
The patient may also be given oral contraceptives instead of devices to regulate the hormone levels and restrict the incidences of Metrorrhagia. For other hormonal abnormalities medication containing estrogen may be given to bring the levels of estrogen back to normal and correcting the menstrual cycle of the female and treat Metrorrhagia.
In case of cancer being suspected as a cause of Metrorrhagia then further studies will be conducted including a biopsy to check the stage of the cancer and further treatment will be given to the patient to include radiation and chemotherapy.
In all cases, it is extremely important that the patient be given iron pills as it is quite normal for the patient to be having very low iron levels as a result of excessive blood loss due to Metrorrhagia.
- American College of Obstetricians and Gynecologists – Abnormal Uterine Bleeding URL: https://www.acog.org/patient-resources/faqs/gynecologic-problems/abnormal-uterine-bleeding
- Mayo Clinic – Menorrhagia (Heavy menstrual bleeding) URL: https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
- National Library of Medicine – Metrorrhagia URL: https://medlineplus.gov/ency/article/001502.htm
- Medscape – Dysfunctional Uterine Bleeding (Metrorrhagia) URL: https://emedicine.medscape.com/article/255540-overview
- Women’s Health Concern – Dysfunctional Uterine Bleeding URL: https://www.womens-health-concern.org/help-and-advice/factsheets/dysfunctional-uterine-bleeding/