Medical causes of abnormal vaginal bleeding

Abnormal vaginal bleeding, not easily explained by the presence of a gynecologic lesion, infection, or hormonal abnormality, may be caused by systemic medical disease. Evaluation of the clotting system, both platelets and clotting factors, should be done to rule out hematologic disorders that can cause blood loss. Additionally, a detailed history, directed physical examination, and carefully chosen laboratory studies can establish the presence of endocrine disease, renal insufficiency, hepatic abnormalities, and vasculitis. Specific questions about diet and drug use may uncover nutritional deficiencies or adverse drug reactions that produce or contribute to abnormal vaginal blood loss. Evaluations for medical causes of vaginal bleeding may require subspecialty consultation to facilitate timely diagnosis.