Context

Vaginal bleeding, either normal menstruation or abnormal bleeding, affects almost all females at some point in their lives and many of these patients are sufficiently concerned to attend the ED.^1–4

Here are some statistics to highlight the scale of the issue:

• Approximately 25% of the UK population are females of reproductive age;⁵
• 14% of women of reproductive age experience abnormal uterine bleeding (AUB);⁶
• Around 5% of GP consultations for women aged 30-49 years relate to heavy menstrual bleeding (HMB).⁷ This does not include the many other causes of vaginal bleeding.

HMB is one of the most common causes of abnormal bleeding. It is defined by the patient’s perception of heavy or excessive bleeding and the affect it has on her life, as opposed to the actual volume of blood lost.^8,9 HMB has a number of consequences for women, leading to the following:

• Iron deficiency anaemia – HMB is one of the leading causes of iron deficiency anaemia in females worldwide;¹⁰
• Blood transfusions and inpatient stays in hospital;
• Missed days at school or work;
• Psychosocial and sexual difficulties.^9,10

Vaginal bleeding can also be a symptom of cancer, particularly gynaecological malignancy, but also haematological cancers. Cancer Research UK report that uterine cancer is the fourth most common cancer in women in the UK, with approximately 9,400 new diagnoses and 2,400 deaths each year.¹¹ Many of these patients present with AUB. Postmenopausal bleeding (PMB) is of particular concern and in one study, 5-10% of women with PMB were found to have endometrial cancer.¹²

Learning bite

Vaginal bleeding can be a huge problem for women and can be a symptom of serious underlying pathology.