Metrorrhagia is defined as irregular, acyclic vaginal bleeding that occurs outside of the normal menstrual period. There are several potential causes of metrorrhagia, including disorders like dysfunctional uterine bleeding, fibroids, polyps, and infections. A doctor will take a patient's medical history and conduct a physical exam to diagnose the cause. Tests like ultrasounds, blood tests, and biopsies may also be used. Treatment depends on the underlying cause but can include lifestyle changes, hormone therapy, surgery to remove growths, or treating any other related medical conditions.

1. METRORHHAGIA
DR.SARASWATI M. SHARMA
DEPATMENT OF OBG

2. DEFINITION
 METRORRHAGIA is defined as IRREGULAR, ACYCLIC bleeding from the uterus. OR
 Metrorrhagia, now commonly called intermenstrual bleeding, is vaginal bleeding that
occurs at irregular intervals not associated with the menstrual cycle. While the blood comes
from the uterus as it does during menstruation, the bleeding does not represent a normal
period. There are several causes of metrorrhagia, some of which are harmless. In other
cases, metrorrhagia can be a sign of a more serious condition.

3. CAUSES
 DUB
 FIBROIDS
 UTERINE POLYP
 CARCINOMA OF CERVIX AND ENDOMETRIAL
 ENDOMERIOSIS
 BREAKTHROUGH BLEEDING IN PILL USE
 IUCD IN UTERO
 DECUBITUS ULCER
 INFECTIONS
 ECTOPIC PREGNANCY and many other

4. SYMPTOMS
 When bleeding occurs outside the expected timeframe of the menstrual cycle, it is sometimes referred to as
abnormal or dysfunctional uterine bleeding.
 Some people who menstruate regularly experience light bleeding or spotting at various times throughout their
cycle, especially at ovulation. In these cases, symptoms such as mild discomfort and spotting at mid-cycle,
may not be unusual for a person.
 However, if you have not experienced these symptoms in the past but suddenly begin having them, your
doctor can help you figure out the cause.
 Metrorrhagia is specific to vaginal bleeding that happens at another time during the month other than when
someone is having or would expect to have their menstrual period.
 Sometimes the bleeding seems to follow a pattern and may feel like you're having “a second period” at
another time during the month. In other cases, the bleeding is completely random and unpredictable.
 When the bleeding occurs it may painless or you may experience cramps and other symptoms associated with
your period, such as bloating.
 Intermenstrual bleeding is often light, but can also be quite heavy. In some cases, it may even be heavier than
your regular period.

5. DIAGNOSIS
 If you are experiencing abnormal vaginal bleeding, your doctor will start by asking you questions about your
general health, particularly your menstrual cycle and sexual activity. They may also ask about the health of
your family members; for example, if your mother or sister has ever been diagnosed with
endometriosis, uterine fibroids, or reproductive cancer.
 Your regular doctor will most likely refer you to a reproductive health practitioner, usually a gynecologist.
This type of doctor is specially educated and trained in reproductive health conditions. If you are pregnant,
you will also need to see an obstetrician or midwife.
 An OBGYN will talk to you more in-depth about your symptoms. They will likely ask you questions about
the bleeding, such as:
 When the bleeding started
 How long it lasts
 Your sexual history
 If you have ever been pregnant and given birth
 They may review any other medical conditions you have or have had in the past, as well as any medications
and supplements you are taking.

6. DIAGNOSIS
 Physical Exam
 Your doctor may also do a rectovaginal exam. Using a lubricated glove,
they will place a finger inside your rectum and vagina. This helps them
feel for any abnormalities.
 A vaginal exam, where they use a speculum to help them see inside the
vaginal canal up to your cervix, may also be done.
 While these exams can cause slight discomfort, they usually do not
take long.
 If you feel uncomfortable physically or emotionally during the exam,
you can tell your doctor or the nurse assisting them that you need to
pause or stop.

7. INVESTIGATION
 The doctor may want to do some other types of tests to help determine the cause of metrorrhagia. They will usually
start with less invasive tests and only move on to interventions like surgery if they think it will be necessary to
correctly diagnose and treat the cause of the bleeding.
 Tests your doctor may order if you are experiencing metrorrhagia include:
 Blood tests to check for disorders that cause bleeding, nutritional deficiencies, infections, markers of inflammation,
and other findings
 Tests to check your hormone levels and thyroid function
 Urine samples to check for pregnancy, infection, or STDs
 Ultrasounds of your abdomen and pelvis, including transvaginal ultrasounds
 CT scans or MRIs
 PAP SMEAR to test for cervical cancer
 Other tissue biopsies to look for other types of cancer
 Surgery (laparoscopy or laparotomy)

8. TRATMENT
 The treatment for metrorrhagia will be specific to its cause, as well as the individual needs
of the patient. Some treatments will be safer and more effective than others. For example,
while hormonal contraception can be used to treat abnormal uterine bleeding, birth control
pills may not be appropriate for a person with a history of blood clots.
 Once your doctor has figured out why you are experiencing metrorrhagia, they can help
you decide on the best way to treat it.

9. TREATMENT
Life style changes
Hormone therapy
D&C
Treating underlying health condition

10. KEY POINT IMAGE

11. MENOMETRORRHAGIA
It is the term applied when the
bleeding is so irregular and
excessive that the menses
cannot be identified at all.

12. HYPOMENORRHOEA
When the menstrual bleeding
is scanty and last for less than
2 days, it is called
hypomenorrhoea.