Major Research Findings

This narrative review aimed to assess the role of office hysteroscopy in managing postmenopausal bleeding (PMB). Office hysteroscopy is a minimally invasive procedure that allows direct visualization of uterine pathology without the need for general anesthesia or an operating room. This leads to cost savings and greater patient compliance. The review focuses on major intrauterine diseases that cause PMB, including polyps, submucosal myomas, endometrial hyperplasia, and cancer. Office hysteroscopy appears to be safe and feasible, and it could provide accurate diagnoses of intrauterine pathologies, especially those with a focal growth pattern, which might otherwise be misdiagnosed with blinded procedures. However, studies focusing exclusively on postmenopausal women are still scarce, so further research, particularly randomized controlled trials, is necessary.

This study retrospectively analyzed the clinical features and investigations of vaginal bleeding in prepubertal children. There were 32 cases, with a mean age of 5.5 years. Vulvovaginitis was the most common diagnosis (37.5%), followed by precocious puberty (15.6%). Rare but serious causes included vaginal rhabdomyosarcoma (1 case) and sexual abuse (1 case presenting with gonorrhea and 1 case with non-accidental injury). Vaginoscopy was performed in nine patients (28.1%), and a vaginal foreign body was identified in two patients (6.3%). All patients with a serious cause of bleeding (neoplasm or sexual assault) or who required specific treatment (precocious puberty, lichen sclerosus, urethral prolapse) presented with red flags on history and/or examination, including recurrent episodes of vaginal bleeding, heavy bleeding, associated general symptoms (poor feeding and growth), presence of thelarche, abdominal mass, associated profuse vaginal discharge, and abnormal genital examination (skin changes, urethral prolapse, or protruding mass from the vagina). This study suggests that thorough history taking and clinical examination aimed at identifying red flags can help distinguish between benign causes of vaginal bleeding, where no further investigations are indicated, and alternative diagnoses with a poor outcome and/or requiring specific treatment and additional investigations. 5

This study characterized the etiology, clinical features, and outcomes of prepubescent vaginal bleeding in a single center in Fujian, China. The data of 158 patients hospitalized with vaginal discharge or bleeding from January 2012 to December 2018 were retrospectively reviewed. The average age was 5.2 years. The most common causes were vaginal foreign bodies, vulvovaginitis, trauma, vaginal malignant tumors, and urethral mucosa prolapse. The study highlights the need for careful medical histories and targeted examinations, and vaginoscopy could be considered. Different treatments should be administered considering the different causes to achieve a good prognosis. 4

Causes of Vaginal Bleeding

Vaginal bleeding can be caused by various factors, including hormonal changes, infections, injuries, and medical conditions. It is crucial to consult a healthcare professional for a proper diagnosis and treatment plan. 5 , 4

Common Causes of Vaginal Bleeding

Vulvovaginitis

Vulvovaginitis is a common cause of vaginal bleeding in prepubertal girls, often caused by infections or irritations. 5 , 4

Precocious Puberty

Precocious puberty, the early onset of puberty, can also lead to vaginal bleeding in prepubertal girls. 5

Vaginal Foreign Bodies

Vaginal foreign bodies, such as small objects inserted into the vagina, are a common cause of vaginal bleeding, particularly in prepubertal girls. 5 , 4

Vaginal Rhabdomyosarcoma

Vaginal rhabdomyosarcoma is a rare cancer that can cause vaginal bleeding in prepubertal girls. 5

Sexual Abuse

Sexual abuse is a serious issue that can lead to vaginal bleeding in children. 5

Urethral Mucosa Prolapse

Urethral mucosa prolapse, a condition where the lining of the urethra protrudes outside the body, can cause vaginal bleeding in prepubertal girls. 4

Ovarian Granulosa Cell Tumors

Ovarian granulosa cell tumors, rare tumors that develop in the ovaries, can cause vaginal bleeding in prepubertal girls. 4

Vaginal Yolk Sac Tumors

Vaginal yolk sac tumors are rare and can cause vaginal bleeding in prepubertal girls. 4

Uterine Arteriovenous Malformation (AVM)

A uterine AVM, a rare condition where there is an abnormal connection between an artery and a vein in the uterus, can cause life-threatening vaginal bleeding. , , ,

Endometrial Polyps

Endometrial polyps are benign growths in the lining of the uterus and can cause postmenopausal bleeding.

Endometrial Hyperplasia

Endometrial hyperplasia is a condition where the lining of the uterus thickens abnormally and can cause postmenopausal bleeding.

Endometrial Cancer

Endometrial cancer is a serious type of cancer that can cause postmenopausal bleeding.

Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of cancer of the blood-forming tissues, and in rare cases, it can cause postmenopausal bleeding.

Management of Vaginal Bleeding

Vulvovaginitis

Treatment for vulvovaginitis typically involves antifungal or antibacterial medications, depending on the cause. 5 , 4

Precocious Puberty

Treatment for precocious puberty typically involves hormone therapy to suppress the early onset of puberty. 5

Vaginal Foreign Bodies

Treatment for vaginal foreign bodies involves removing the object from the vagina. 5 , 4

Vaginal Rhabdomyosarcoma

Treatment for vaginal rhabdomyosarcoma typically involves a combination of surgery, chemotherapy, and radiation therapy. 5

Sexual Abuse

Management of sexual abuse involves providing support to the victim, including counseling, legal support, and medical care. 5

Urethral Mucosa Prolapse

Treatment for urethral mucosa prolapse typically involves surgery. 4

Ovarian Granulosa Cell Tumors

Treatment for ovarian granulosa cell tumors typically involves surgery, chemotherapy, and/or radiation therapy. 4

Vaginal Yolk Sac Tumors

Treatment for vaginal yolk sac tumors typically involves surgery. 4

Uterine Arteriovenous Malformation (AVM)

Treatment for uterine AVM typically involves uterine artery embolization, a minimally invasive procedure to block the blood flow to the malformation. , , ,

Endometrial Polyps

Endometrial polyps can be treated by removal via hysteroscopy or dilation and curettage (D&C).

Endometrial Hyperplasia

Treatment for endometrial hyperplasia depends on the severity of the condition and can involve hormone therapy or surgery.

Endometrial Cancer

Treatment for endometrial cancer typically involves surgery, chemotherapy, and/or radiation therapy.

Chronic Lymphocytic Leukemia (CLL)

Treatment for CLL involves chemotherapy, radiation therapy, and/or bone marrow transplant.

Comparison of Research

Similarities

All research studies emphasize that vaginal bleeding can be caused by a wide range of factors. The studies also underline the importance of a thorough medical history and examination to correctly identify the underlying cause of vaginal bleeding. 5 , 4

Differences

These research studies vary in the age groups they focus on, with some focusing on prepubertal children and others on postmenopausal women. 5 , 4 ,

Practical Implications

Vaginal bleeding can be caused by a variety of reasons, and self-treating can be dangerous. If you experience vaginal bleeding, it is crucial to seek medical attention for a proper diagnosis and treatment plan. 5 , 4 ,

Limitations of Current Research

Further research, especially randomized controlled trials, is needed to fully understand the effectiveness and safety of office hysteroscopy for managing postmenopausal bleeding, as studies focusing exclusively on this population are still limited.

Future Research Directions

More research is necessary to understand the causes and treatment options for vaginal bleeding, particularly in postmenopausal women. Further research, such as randomized controlled trials, is needed to assess the efficacy and safety of office hysteroscopy in this population.

Conclusion

Vaginal bleeding can have various causes and self-treating can be dangerous. It is essential to consult a healthcare professional for a proper diagnosis and treatment plan. 5 , 4 ,