Metrorrhagia
Metrorrhagia—uterine bleeding that occurs irregularly between menses—is usually light, although it can range from staining to hemorrhage. Usually, this common sign reflects slight physiologic bleeding from the endometrium during ovulation. However, metrorrhagia may be the only indication of an underlying gynecologic disorder and can also result from stress, drugs, treatments, and intrauterine devices.
History and physical examination
Begin your evaluation by obtaining a thorough menstrual history. Ask the patient when she began menstruating, the duration of menses, the interval between them, and the average number of tampons or pads she uses each month. Establish when metrorrhagia occurs in relation to her menses. Does she experience other signs or symptoms? Find out the date of her last menses, and ask about other changes in her normal menstrual pattern. Ask for details of previous gynecologic problems. If applicable, obtain a contraceptive and obstetric history. Record the dates of her last Papanicolaou (Pap) smear and pelvic examination. Ask the patient if she is sexually active. Next, ask about her general health and any recent changes. Is she under emotional stress? If possible, obtain a pregnancy history of the patient's mother. Was the patient exposed in utero to diethylstilbestrol? (This drug has been linked to vaginal adenosis.)
Prepare the patient for a pelvic examination if indicated, and obtain blood samples and a urine specimen for pregnancy testing.
Medical causes
Cervicitis.Cervicitis may cause spontaneous bleeding, spotting, or posttraumatic bleeding. Assessment reveals red, granular, irregular lesions on the external cervix. Purulent vaginal discharge (with or without odor), lower abdominal pain, and fever may occur.
Dysfunctional uterine bleeding. Abnormal uterine bleeding not caused by pregnancy or major gynecologic disorders usually occurs as metrorrhagia, although menorrhagia is possible. Bleeding may be profuse or scant, intermittent or constant.
Endometrial polyps.In most patients, endometrial polyps cause abnormal bleeding, usually intermenstrual or postmenopausal; however, some patients do remain asymptomatic.
Endometriosis.Metrorrhagia (usually premenstrual) may be the only indication of endometriosis or it may accompany cyclical pelvic discomfort, infertility, and dyspareunia. A tender, fixed adnexal mass may be palpable on bimanual examination.
Endometritis.Endometritis causes metrorrhagia, purulent vaginal discharge, and enlargement of the uterus. It also produces fever, lower abdominal pain, and abdominal muscle spasm.
Gynecologic cancer.Metrorrhagia is commonly an early sign of cervical or uterine cancer. Later, the patient may experience weight loss, pelvic pain, fatigue and, possibly, an abdominal mass.
Uterine leiomyomas.Besides metrorrhagia, uterine leiomyomas may cause increasing abdominal girth and heaviness in the abdomen, constipation, and urinary frequency or urgency. The patient may report pain if the uterus attempts to expel the tumor through contractions and if the tumors twist or necrose after circulatory occlusion or infection, but the patient with leiomyomas is usually asymptomatic.
Vaginal adenosis.Vaginal adenosis commonly produces metrorrhagia. Palpation reveals roughening or nodules in affected vaginal areas.
Other causes
Drugs.Anticoagulants and oral, injectable, or implanted contraceptives may cause metrorrhagia.
Surgery and procedures.Cervical conization and cauterization may cause metrorrhagia.
Nursing considerations
▪ Encourage bed rest to reduce bleeding.
▪ Give an analgesic for discomfort.
Patient teaching
▪ Explain signs and symptoms that require immediate attention.
▪ Explain all procedures and treatments.
▪ Discuss the importance of regular gynecologic examinations and Pap smears.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Vaginal symptoms
Read excerpts from these other book chapters related to Vaginal symptoms:
Medical Books Excerpts
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Urethral Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Vaginal symptoms
» Next page: Urethral discharge (Nursing: Interpreting Signs and Symptoms)
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