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Nonmenstrual bleeding in women under 40 years of age

General Practitioner at The Ridge Medical Practice, Bradford, UK.

Siân Esther Jones, FRCOG, Consultant Obstetrician and Gynaecologist

Bradford Royal Infirmary, Department of Obstetrics and Gynaecology, Duckworth Lane, Bradford, BD9 6RJ, UK. email: sian.jones{at}bradfordhospitals.nhs.uk (corresponding author)

The complaint of nonmenstrual bleeding, either intermenstrual or postcoital, is a common symptom among women. This complaint is often the result of minor alterations of physiological events caused by the influence of endogenous or exogenous hormones. It is often also associated with a high degree of anxiety. This review briefly outlines the causes of this symptom in this younger age group of women and recommends an evidence-based approach to their investigation and subsequent management. It is important to ensure that the investigations are rational, relevant and streamlined in order to give reassurance or to begin appropriate treatment without undue delay. Premature ovarian failure is not included in this review. Women in this group who present with bleeding should be investigated as for postmenopausal bleeding.

Keywords Keywords / intermenstrual bleeding / postcoital bleeding / cervical ectropion / pelvic inflammatory disease (PID) / hysteroscopy