Hemorrhaging: Breakthrough bleeding - The Causes and Risk Factors

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.

H. Breakthrough bleeding 
Breakthrough bleeding is defined as a condition of an abnormal flow of blood from the uterus that occurs between menstrual periods especially due to irregular sloughing of the endometrium in women on contraceptive hormones(1).

H.1. Causes and Risk factors
1. Excessive thick uterine lining (edometrium) 
During the last stage of the menstrual cycle, normally a layer of endometriosis lining on the inside of the uterus is expelled, known as menstruation blood. In some women, excessive thick of uterine lining (edometrium) may cause breakthrough bleeding.

2. Hormonal fluctuations
Fluctuating hormones around ovulation may experience breakthrough bleeding.

3. Taking oral contraceptives
In the study of  dilated thin-walled blood and lymphatic vessels in human endometrium: a potential role for VEGF-D in progestin-induced break-through bleeding, researchers at the Department of Obstetrics and Gynaecology and Monash Institute for Medical Research, Monash University, wrote that using a NOD/scid mouse model with xenografted human endometrium we were able to show that progestin treatment causes decidualisation, VEGF-D production and endometrial vessel dilation. Our results lead to a novel hypothesis to explain BTB, with stromal cell decidualisation rather than progestin treatment per se being the proposed causative event, and VEGF-D being the proposed effector agent(2).

4.  Amenorrhea
In the study of The induction of amenorrhoea by Hipkin LJ. indicated that a survey has shown that many women favour eliminating menstruation and it has been suggested that therapeutic induction of amenorrhoea might be an advantage in female personnel mobilised for war, but it poses some side effects including bleeding and spotting, 2 kg weight gain, breast tenderness, depression, and headaches(3).

5. Progestin treatment
Clinicians routinely prescribe progestins along with estrogens during menopausal hormone therapy (HT) to block estrogen-dependent endometrial proliferationmay cause breakthrough bleeding.

6. Polyps
In teh study to determine the effectiveness of different treatments for abnormal uterine bleeding in women with known endometrial polyps, showed that  polypectomy and other treatments of women with abnormal uterine bleeding who had benign polyps detected by sonohysterography. Women with endometrial polyps diagnosed by sonohysterography between January 1997 and July 1998 were sent questionnaires on pretreatment and posttreatment uterine bleeding and satisfaction with their treatments(4).

7. Other causes
Stopping or missing estrogens or oral contraceptives, stress, weight gain or loss, diet change, displaced intra uterine device, vagina injury, taking anticoagulant medications, etc.(5)

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Sources
(1) http://www.merriam-webster.com/medical/breakthrough%20bleeding
(2) http://www.ncbi.nlm.nih.gov/pubmed/22383980
(3) http://www.ncbi.nlm.nih.gov/pubmed/1533675 
(4) http://www.ncbi.nlm.nih.gov/pubmed/11084172 
(5) http://www.targetwoman.com/articles/breakthrough-bleeding.html