Nonmenstrual

Nonmenstrual is a term used in medicine to describe phenomena not related to the menstrual cycle. In gynecology, it commonly refers to vaginal bleeding that occurs outside the expected period, including intermenstrual bleeding, breakthrough bleeding associated with contraception, postcoital bleeding, and postmenopausal bleeding. It may also describe nonmenstrual symptoms or findings that are not tied to a cycle.

Causes vary and range from benign to serious. Hormonal fluctuations (as seen with new or adjusted hormonal contraception, perimenopause), cervical or endometrial polyps, uterine fibroids, infections such as cervicitis or endometritis, and pregnancy-related events (early pregnancy, miscarriage) are frequent. Less common but important causes include endometrial cancer risk in postmenopausal individuals, atrophic vaginitis in older people, and coagulation disorders or medications that affect clotting.

Evaluation typically starts with a history and pregnancy test, followed by pelvic examination. Depending on findings, assessment may include transvaginal ultrasound, urinalysis, and blood tests. Endometrial sampling or referral to a gynecologist may be indicated for persistent, heavy, or postmenopausal bleeding or when cancer risk is a concern.

Management targets the underlying cause. Not all nonmenstrual bleeding requires intervention, but significant or persistent bleeding may require hormonal therapy, treatment of infections, removal of polyps, fibroid-directed options, or surgical procedures. Addressing anemia and counseling on contraception may also be part of care.