Definition
Metrorrhagia is a loss of uterine blood that goes beyond the normal blood loss related to the menstrual cycle; in fact, it generally occurs in the intermenstrual period. When metrorrhagia appears during menstruation it is called menorrhagia (the result is profuse blood loss); if instead the flow, in addition to being abundant, also continues in the intermenstrual phase, one speaks more correctly of menometrorrhagia.
Metrorrhagia during puberty
Although metrorrhagia mainly affects women of childbearing age, there is no lack of cases in puberty and in the post-menopausal period. Some sporadic metrorrhagic manifestations were also noted during childhood, mostly associated with pathologies of another nature; in the so-called precocious puberty, the girl becomes a woman early. In the new woman, sexual development is premature and manifests itself with breast growth, development of the genital organs, growth of pubic and axillary hair, the onset of menstruation and expansion of the uterus in volumetric terms: all these factors are related to hormonal modulation and may reflect a possible endocrine imbalance. In this phase, all metabolic-physiological processes must be speeded up inside the organism: in this regard, often the regulation systems go into tilt, causing phenomena such as, for example, alterations in the menstrual cycle, menorrhagia, dysmenorrhea and metrorrhagia. It is good to remember that during the onset of the first menstruation - which coincides with the period of transformation from girl to woman - it is difficult to distinguish metrorrhagia from menorrhagia, since the menstrual cycle has yet to stabilize, so much so that, more often than not, it is not even possible to distinguish menstruation itself from extra-menstrual bleeding.
Metrorrhagia in the adult woman
Generally, the most serious causes that cause metrorrhagia in adult women are found in tumors of the uterus (eg fibroids, benign mucous polyps, malignant neoplasms) and in acute inflammation of the endometrium.
Sometimes, abundant genital blood loss is a sign of spontaneous abortion: it has been verified that some women, especially during the first pregnancy, experience a spontaneous abortion a few weeks after conception, of which metrorrhagia represents the first alarm bell.
In other cases, metrorrhagia could present a less "dangerous" etiological picture: similar to menorrhagia, metrorrhagia can in fact be the "simple" result of transient hormonal alterations. It is no coincidence, for example, that in the first three months of taking the contraceptive pill - a moment of strong endocrine imbalance - the woman complains of sudden and unexpected uterine bleeding between one menstruation and the next. If the history of intermenstrual bleeding continues even after the first three months of treatment, metrorrhagia probably depends on other factors.
Obviously, even the introduction of foreign bodies into the vagina could cause uncontrolled bleeding.
Therefore, in general, local organic factors (submucosal and intramural fibroids in particular, uterine inflammation, cervical polyps, malignant tumors) and general (modification of blood coagulation, heart diseases, infections and heavy metal intoxications), associated with functional alterations of regulation of the menstrual cycle, represent the most frequent causes that contribute to the onset of metrorrhagia in adult women.
Metrorrhagia in menopause
We have analyzed the first two phases of a woman's life (puberty and adulthood): however, we have mentioned that metrorrhagia can also appear shortly before and during menopause, a period in which the woman is no longer fertile. In the event that the woman manifests metrorrhagia in the phase preceding the menopause (climacteric), the aforementioned condition can be considered pseudo-physiological; in this period of life, the organism is in fact subjected to a strong hormonal modulation in preparation to menopause, for which intermenstrual losses can generally be considered physiological and separated from particular problems.
If metrorrhagia also occurs during menopause, this unexpected and abundant blood loss can no longer be considered physiological: in general, metrorrhagia in menopause is in fact a sign of rather serious pathologies (cervical cancer and uterine carcinoma). Precisely because in menopause, metrorrhagia could turn out to be very serious, it would therefore be advisable to contact the gynecologist as soon as possible, since an immediate diagnosis and timely treatment guarantee, in most cases, positive therapeutic implications.
Effects and treatments
In all stages of a female's life, with particular reference to puberty, adulthood and menopause, frequent bleeding could cause alterations in the concentration of iron in the blood, giving rise to situations of secondary (ie induced) anemia: in similar circumstances, the gynecologist can recommend an iron supplement to remedy the deficiencies. In the most serious cases, in which the woman complains of excessive blood loss, transfusions could be used to remedy the consequences deriving from severe bleeding.
If the cause that causes the metrorrhagia is represented by hormonal alteration, the patient, upon medical prescription, could take hormones for the rebalancing of the estrogenic structure.
Summary
To fix the concepts ...
I disturb
Metrorrhagia
Description
Genital blood loss that occurs regardless of the menstrual cycle
Childhood (rare), puberty, adulthood, menopause
In precocious puberty, the girl becomes a woman more quickly and the organism is forced to undergo hormonal and physiological alterations that can lead to episodes of metrorrhagia
The abundant intra-menstrual blood loss can be a sign of spontaneous abortion or cancers of the genital tract; hormonal alterations can also favor the manifestation of metrorrhagia
In this period, the alterations of the menstrual cycle are pseudo-physiological: the woman's body prepares itself and the functional and hormonal mechanisms are altered to prepare for menopause
Metrorrhagia is no longer considered normal, on the contrary, unexpected and abundant losses can be a sign of carcinoma
Aetiopathogenesis
Submucosal and intramural fibroids, uterine inflammation, cervical polyps, malignant tumors, alteration of the mechanisms of regulation of the menstrual cycle, functional alterations, modification of blood coagulation, heart diseases, infections and intoxications by heavy metals, are the factors most responsible for metrorrhagia
Hormone treatment, iron supplementation and transfusions (in cases of severe bleeding)
