Metrorrhagia

Abnormal, irregular, noncyclic uterine bleeding occurring outside the expected timing or pattern of normal menstruation, often reflecting disrupted endometrial regulation, structural uterine disease, pregnancy-related pathology, infection, medication effects, or malignancy.

Causes

• Hormonal and endocrine causes

  • Anovulatory cycles

  • Polycystic ovary syndrome (PCOS)

  • Thyroid disorders

  • Puberty-related hormonal immaturity

  • Perimenopause-related hormonal fluctuations

  • Stress-related hypothalamic–pituitary dysfunction

  • Significant weight gain or weight loss

• Structural uterine causes

  • Uterine fibroids (leiomyomas)

  • Endometrial polyps

  • Adenomyosis

  • Endometriosis

  • Uterine structural abnormalities

• Pregnancy-related causes

  • Miscarriage

  • Ectopic pregnancy

  • Retained products of conception

• Infectious and inflammatory causes

  • Pelvic inflammatory disease (PID)

  • Cervicitis

  • Sexually transmitted infections (STIs)

  • Chronic endometritis

• Medications affecting coagulation or reproductive hormones

  • Hormonal contraception

  • Intrauterine devices (IUDs)

  • Anticoagulants

  • Antiplatelet medications

• Malignant causes

  • Endometrial cancer

  • Cervical cancer

• Coagulopathy

  • Bleeding disorders (von Willebrand disease)

  • Liver disease causing impaired coagulation

  • Kidney disease associated with platelet dysfunction