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Prepubertal Age Group Slight vaginal bleeding can occur within the first few days of life because of withdrawal from the high level of maternal estrogens.
Vaginal bleeding in the absence of secondary sexual characteristics should be evaluated very carefully. Prepubertal Age Group The causes of bleeding range from the medically mundane to malignancies that may be life- threatening. Causes of Vaginal Bleeding in Prepubertal Girls Vulvar Lesions –Vulvar irritation –maceration of the vulvar skin, –or fissures can bleed.
Foreign Body A foreign body in the vagina is a common cause of vaginal discharge, which may appear purulent or bloody.
Precocious Puberty Precocious puberty occasionally is marked by vaginal bleeding in the absence of other secondary sexual characteristics, it is more common for the onset of breast budding or pubic hair growth to occur before vaginal bleeding. Trauma A careful history should be obtained from –one or both parents or –caretakers –and the child herself, because trauma caused by sexual abuse is often not recognized. Other Causes Other serious but rare causes of true vaginal bleeding include vaginal tumors.
Adolescence To assess vaginal bleeding during adolescence, it is necessary to have an understanding of the range of normal menstrual cycles.
Abormal bleeding Cycles > 42 days, 7 days during adolescence greater irregularity is acceptable if significant anemia or hemorrhage is not present. Anovulatory bleeding The physiology - failure of the feedback mechanism In anovulatory cycles, estrogen secretion continues, resulting in endometrial proliferation with subsequent unstable growth and incomplete shedding.

Exogenous Hormones Oral contraceptive use is associated with breakthrough bleeding, which occurs in as many as 30% to 40% of individuals during the first cycle of combination pill use. Hematologic Abnormalities Idiopathic Thrombocytopenic Purpura (ITP), von Willebrand's disease. Reproductive Age Group Beyond the first 1 to 2 years after menarche, menstrual cycles generally conform to a cycle length of 21 to 35 days, with a duration of less than 7 days of menstrual flow.
Reproductive Age Group Although the most frequent cause of irregular bleeding is hormonal disorder Pregnancy-related bleeding (spontaneous abortion, ectopic pregnancy) should always be considered.
Anatomic Causes Anatomic causes of abnormal bleeding in women of reproductive age occur more frequently than in women in other age groups.
Neoplasia Abnormal bleeding is the most frequent symptom of women with invasive cervical cancer.
Nonsurgical Management Most bleeding problems, including anovulatory bleeding can be managed nonsurgically.
Hormonal management (OC) Low-dose oral contraceptives may be used: –during the perimenopausal years –in healthy nonsmoking women –who have no major cardiovascular risk factors. For patients in whom estrogen use is contraindicated, progestins, both oral and parenteral, can be used to control excessive bleeding. Wide range of surgical options from hysteroscopy with resection of submucous leiomyomas to laparoscopic techniques of myomectomy to uterine artery embolization to endometrial ablation to hysterectomy (TAH+BSO). Abnormal bleeding Abnormal Bleeding Prepubertal Age Group –Adolescence Reproductive Age Group Postmenopausal Women.

The source - sometimes difficult to identify, and parents who observe blood in a child's diapers or panties may be unsure of the source.
Adolescents have the highest rates of pelvic inflammatory disease (PID) of any age group when only sexually experienced individuals are considered.
Occasionally, chronic endometritis will be diagnosed when an endometrial biopsy is obtained for evaluation of abnormal bleeding in a patient without specific risk factors for PID. As a woman approaches menopause, cycle length becomes more irregular as more cycles become anovulatory. Endometrial, cervical, and ovarian malignancies must be ruled out in cases of postmenopausal bleeding. The problems of acute, cyclic, and chronic pelvic pain encompass a large proportion of gynaecologic complaints. Adolescents who have severe menorrhagia, especially at menarche, should be screened for coagulation abnormalities, including von Willebrand's disease. The Pap test results are negative in some cases of invasive cervical carcinoma because of tumor necrosis => biopsy, or conisation !!!. 2.The assessment of the relative advances, risks, benefits, complications, and indications of these procedures is a subject of ongoing clinical research.

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