Evaluation of vaginal bleeding

Summary

Classification

Abnormal vaginal bleeding is classified by age and gravidity:

Before menarche
During reproductive years: non-pregnant
During reproductive years: pregnant
Postmenopausal

Disorders of menstrual bleeding, including intermenstrual bleeding, are discussed in the topic, Evaluation of abnormal uterine bleeding .

Epidemiology

Vaginal bleeding before menarche is uncommon and is most often caused by trauma.[1]

Prevalence estimates for postcoital bleeding vary from 0.7% to 9% among women of reproductive age.[2] [3] [4] Incidence is highest among patients ages 26-30 years.[5]

Bleeding during early pregnancy is common, affecting 25% of women during the first trimester.[6] [7]

Up to 11% of women report postmenopausal bleeding, with highest rates in the first year after the menopause.[8]

Citations

Key Articles

Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]
National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. Jun 2026 [internet publication].[Full Text]
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 193: tubal ectopic pregnancy. Mar 2018 [internet publication].
American College of Radiology. ACR appropriateness criteria: first trimester vaginal bleeding. 2025 [internet publication].[Full Text]

Referenced Articles

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Diseases