Many of the leg blood circulation problems are common in both men and women. However, in certain conditions, such as during pregnancy, menopause, or as a result of hormone treatment, some of these problems may worsen or the risks increase substantially. For example, hormonal changes during pregnancy and increased blood volume may cause the veins to dilate and become less elastic. In addition, the pressure on the pelvic blood vessels by the baby’s head and the enlarged uterus may compress the veins and produce varicose veins and various blood circulation problems in the legs.

The common symptoms of poor leg circulation are tingling, numbness, pain and leg cramps. If not treated in time, it can lead to serious complications such as gangrene which may even necessitate amputation of the affected leg in extreme cases. Pulmonary embolism is another dreaded complication which is potentially life-threatening. Lifestyle changes and management of the underlying condition may help. Other specific treatments will depend upon the type of circulation problem.

Risk Factors

• Diabetes.
• High blood pressure (hypertension).
• High blood cholesterol.
• Heart disease.
• Stroke.
• Smoking.
• Obesity.
• Prolonged immobilization.
• Standing for long periods.
• Abnormalities in the blood vessels.
• Injury to blood vessels.
• Kidney disease.
• Pregnancy.
• Hormone treatment.
• Certain medication, such as beta blockers.

Types of Blood Circulation Problems in the Leg

Peripheral Vascular Disease

Peripheral vascular disease, also referred to as peripheral arterial disease, may affect women particularly if there is a history of diabetes, hypertension, high blood cholesterol, or heart disease. Smoking also increases the risk. Peripheral arterial disease is a blood circulation problem that commonly affects the legs. Due to hardening of the arteries or arteriosclerosis, the arteries lose their elasticity and also become narrower, thus causing less blood flow to the supplying area. Extreme cold, emotional stress, abnormalities in the blood vessels and injuries to the blood vessels can also lead to blood circulation problems in the legs.

PAD usually results in symptoms such as tingling, numbness, aches and pains, or discomfort in the legs, particularly of the calf muscles. This occurs while walking or during exercise and is usually relieved on rest. The affected leg may look pale and be cold to the touch. As it progresses, PAD may lead to leg pain and cramps at night or non-healing ulcers in the leg. There is a greater chance of a blood clot forming in these affected leg arteries – arterial thrombosis. Sometimes a blood clot forms even when the artery is not blocked more often due to a heart condition known as atrial fibrillation.

Varicose Veins

Varicose veins are dilated veins on the surface of the legs. Varicose veins are usually caused by a condition known as venous insufficiency where the valves in the veins (which normally act as one-way valves allowing blood to flow back to the heart) become incompetent, and blood flows back into the legs. This can cause edema or swelling of the legs and varicose veins. Varicose veins are more common in women than in men. The risk of developing varicose veins increases during pregnancy.

Deep Vein Thrombosis

A single blood clot or multiple blood clots in the leg veins can lead to a condition known as deep vein thrombosis (DVT). This usually occurs due to prolonged immobilization as in long journeys by car or airplane, or after surgery. Women may be especially at risk if they are on birth control pills, are pregnant, or have recently given birth. Postmenopausal women, particularly those on hormone replacement therapy (HRT), are at increased risk.

Pain and edema are the most important symptoms of DVT. The affected leg will be warm to the touch. DVT results in restriction of blood flow from the leg veins to the heart. The most feared complications of DVT is pulmonary embolism which may occur if a clot breaks away into the blood stream and blocks a blood vessel in the lungs.

Hemorrhoids or piles are swollen, painful, and inflamed veins in and around the anus and lower rectum. It is a common condition in both men and women, usually occurring due to straining when passing stool which is common in chronic constipation. Women are prone to develop hemorrhoids, especially during pregnancy and childbirth. The most common symptom is the passage of bright red blood while passing stool or when wiping after a bowel movement.

Causes and Risk Factors of Hemorrhoids

Increased pressure in the veins of the rectum and around the anaus results in swelling of the veins. This causes pain, especially on straining during bowel movements or while sitting. Rupture of the swollen veins may result in bleeding. Straining while passing stool is the most important cause associated with development of piles. This usually results due to constipation. Since constipation is a common symptom during pregnancy, hemorrhoids may develop or get aggravated during this time, especially during the third trimester.

Pressure of the growing uterus on the pelvic veins and inferior vena cava during pregnancy causes a slowing of venous return from lower part of the body, resulting in stagnation of blood in the veins and their subsequent dilation. Increased progesterone levels during pregnancy also contribute to piles formation by causing swelling of the veins due to relaxation of the venous walls. Progesterone also causes slowing down of the intestinal tract, leading to constipation.

Sitting for long periods of time is another common cause of hemorrhoids. Women who have had hemorrhoids before pregnancy are more likely to suffer from them again during pregnancy. Hemorrhoids may be caused during childbirth due to the bearing down efforts or pushing during the second stage of labor. Following childbirth, piles is a common complaint.

Types of Hemorrhoids

Hemorrhoids are of two types. Those situated inside the anus and lower rectum are known as internal hemorrhoids, while those situated under the skin around the anus are known as external hemorrhoids. In some cases, the enlarged internal hemorrhoids pull down the rectal lining and may protrude from the anus. These are known as prolapsing internal hemorrhoids.

Internal hemorrhoids may be graded according to their severity into the following groups

• First degree hemorrhoids have symptoms of bleeding but they do not prolapse.
• Second degree hemorrhoids are those that prolapse and retract on their own. Bleeding may or may not be present.
• Third degree hemorrhoids are those that prolapse but do not retract on their own. They may be pushed back in by a finger.
• Fourth degree hemorrhoids are those that prolapse but cannot be pushed back in. These include thrombosed piles or prolapsed piles.

Symptoms of Hemorrhoids

The passage of varying quantities of bright red blood during or after a bowel movement is the most common symptom of hemorrhoids. This is sometimes accompanied by pain which is also likely while sitting. Anal itching is a common symptom. Hard, painful lumps may be felt near the anus.

Diagnosis of Hemorrhoids

Diagnosis is usually made from the history, followed by a rectal examination. Other tests that may be done are stool guaiac, sigmoidoscopy, and anoscopy.

Treatment of Hemorrhoids

Treatment usually consists of a Sitz bath (sitting in a warm bath for 10 to 15 minutes) and application of corticosteroid creams to reduce pain and swelling or hemorrhoid creams with lidocaine to relieve pain. A high-fiber diet and lifestyle changes can help. Avoiding constipation and use of stool softeners is advisable. Infrared coagulation (heat treatment) or sclerotherapy (injection of a chemical solution within the vein) may help to shrink the piles. When all else fails to control bleeding or pain, surgery may be advised. This includes rubber band ligation or hemorrhoidectomy (surgical removal of hemorrhoids). Stapled hemorrhoidectomy blocks blood flow to the hemorrhoidal tissue.

Not only are cracked heels and soles unsightly to look at, they can cause pain or discomfort in the feet. Bleeding may occur in severe cases. Infection may also occur, particularly if the person is diabetic. Simple measures such as proper foot care, with particular emphasis on keeping the feet well-moisturized, may help to prevent cracked heels and soles of the feet. If not dealt with early, the skin around the heels may become thick and callused with deep fissures in it, which will make healing more difficult.

Causes of Cracked Heels

Dry skin may predispose to development of cracked heels. Callus (dry, thickened skin) formation around the heels may lead to cracked heels. This can be caused by pressure on the heels caused by prolonged standing. Increased pressure on the fat pad under the heel makes it expand sideways which ultimately leads to splitting or cracking of the callus. Obesity may be another predisposing factor. People who go barefoot or those wearing sandals or shoes that are open at the heel are more prone to cracked heels.

Skin conditions such as eczema and psoriasis may cause this problem. Medical conditions such as diabetes and thyroid problems may also predispose to cracked heels. Sweating of the feet for a prolonged period wearing socks or shoes may make the feet soggy, as well as working barefoot in damp or waterlogged conditions. This may cause the heels to crack. Fungal infections can further aggravate the problem.

Symptoms of Cracked Heels

The initial symptom of cracked heels is callus formation around the heel. The skin will be thickened, dry, and hard and small cracks may be seen over it. If neglected at this stage, the cracks will become deeper and can cause pain or discomfort on standing or walking. Bleeding may occur from deep cracks. The cracks may become infected and result in cellulitis in severe cases.

Neuropathic changes in diabetic patients often result in decreased sensation in the feet. In such cases, even severely cracked feet may be ignored due to lack of pain sensation. Such patients are at risk of developing foot ulcers which are often difficult to heal.

Treatment of Cracked Heels

A little care can help to prevent cracked heels. Keeping the heels well-moisturized, especially in the winter months or in dry weather, can not only prevent the formation of calluses and cracked heels, it can heal the condition in the initial stages. Soaking the feet in warm water for 10 to 15 minutes, followed by rubbing gently with a pumice stone can remove the thickened skin. This may be followed by application of a moisturizer to keep the feet soft and smooth. Heel balms containing keratolytic or water-retaining agents may be used, such as urea, salicylic acid, alpha-hydroxy acids, or saccharide isomerate. In case of deep fissures, a liquid, gel, or spray bandage can help to protect the area and allow it to heal, as well as relieve pain.

A podiatrist may be consulted in severe cases that are not amenable to the above measures. Treatment may involve :

• Identifying the cause and treatment of the underlying condition such as diabetes.
• Appropriate antibiotics in case of infection.
• Debridement or removal of the hard skin by cutting it away.
• Strapping the heels with bandage or dressing.
• Use of softening or debriding agents such as urea or salicylic acid.
• Use of heel pads, heel cups, or insoles.
• Special tissue glue that can hold the cracked skin together, thus allowing it to heal.
• Advice regarding appropriate footwear.
• Maintaining proper foot care at home on a regular basis.

Causes of Jock Itch in Women

Jock itch is mainly caused by a certain type of skin fungi known as dermatophytes. The two species that are most likely to be responsible for a groin skin fungus is Trichophyton rubrum and Epidermophyton floccosum. Less often, other Trichophyton species and Candidia (yeasts) may also cause a fungal infection of the skin. Although many people are exposed to these fungi, a skin infection only occurs in some. There are number of known risks but even in the face of these factors, it appears that individual susceptibility which may be genetic or some other as yet unidentified mechanism is a major component of developing fungal infections of the skin.

A fungal infection of the groin is more likely to arise with some underlying skin disease. A common predisposing factor in this regard is intertrigo – chaffing of the skin. This is more common in obese women where the skin folds provide two opposing surfaces for abrasion. Another factor in terms of chaffing is tight underwear which may irritate the skin in the area and make it prone to a fungal infection. Furthermore, the groin area is generally warm and moist as it is covered for most of the day and this provides the ideal conditions for fungi to thrive.

Although jock itch is more common in males, it is likely to arise in any person with one or more of these risk factors apart from those mentioned above :

• Living in a hot and humid climate
• Poorly fitting undergarments – too tight
• Using repeat courses of broad spectrum antibiotics
• Diabetes mellitus
• Immune deficiency
• Excessive sweating
• Poor personal hygiene
• Wearing wet clothes
• Not wiping dry properly after bathing
• Sharing personal items such as towels or underwear with an infected person

Signs and Symptoms of Jock Itch

The most common symptom is an itchy skin rash. It is usually a persistent itch which may ease with scratching but tends to return a short while later. The skin tends be scaling or peeling and while the area is initially red, it gradually becomes darker in color. A person often finds small specks of skin after scratching the area intensely. Sometimes there is musty odor with dampness in the area even without sweating. Burning, pain and heat in the area with a foul smelling discharge may indicate a superimposed bacterial infection.

Treatment of Jock Itch in Women

There are a number of topical and oral medication that can help to eradicate the fungus. Antifungal shampoo should be used in the area at least twice a week and antifungal cream should be applied to the area at least twice a day after bathing. Underwear needs to be changed twice daily and older underwear should be discarded at the start of treatment as it may contain fungal spores which can re-infect the area. The area must be kept dry with thorough wiping after bathing and using an antifungal drying powder if necessary. Oral antifungal drugs are only considered if the infection does not respond to topical applications. A low dose corticosteroid cream may help to relieve itching but long term use should be avoided as it can weaken the skin. Antibiotics are necessary when there is a secondary bacterial infection.

Most women experience some degree of abdominal distention particularly before and during menstruation. It can be a temporary inconvenience for many, although some women will experience recurrent episodes of distention throughout the month irrespective of menstruation. There is often a misconception that this distention, referred to as menstrual bloating, is due to fluid. In fact many women may complain of retaining water in the abdomen and some may even use water pills to counteract the bloating. However, abdominal distention during menstrual periods is unlikely to be caused by fluid retention. It most instances it is actually functional bloating – a condition that occurs by an unknown mechanism apparently in response to hormonal changes. Functional bloating is not related to any underlying disease and will resolve spontaneously with no need for medical attention. Fluid retention in the abdomen, however, is not as innocuous.

Causes of Abdominal Fluid Retention

The organs of the abdomen are lined with a membranous layer known as the visceral peritoneum which is continuous with the parietal peritoneum that lines the inner abdominal wall. Between these two peritoneal layers is a potential space known as the peritoneal cavity. It contains a very small amount of peritoneal fluid that aids with lubrication. Women may find that the amount of peritoneal fluid can increase with changes in the menstrual cycle – this may increase to as much as 20mL. However, it causes no signs and symptoms. In fact for fluid retention to be detectable by diagnostic investigation, it needs to be around 100mL to 200mL. For this fluid retention to be visible, it needs to be above 500mL and for it to cause a massive increase in abdominal girth, the fluid volume needs to exceed 1,000mL.

Fluid retention in the abdominal cavity, or more correctly the peritoneal cavity, is known as ascites. It is a medical condition that needs to be assessed, treated and managed appropriately. Most causes of ascites are related to liver conditions like cirrhosis, hepatitis and other liver diseases including liver cancer. It may also be associated with inflammation of the peritoneal layers (peritonitis), pancreatic, heart, blood and kidney disease and malignancies in the area. Less commonly, ascites may be seen with thyroid dysfunction, systemic lupus erythematosus (SLE), ovarian dysfunction and tuberculosis among other conditions.

Treatment of Ascites

Ascites (fluid retention in the abdomen) needs to be investigated in order to identify the underlying cause. Treatment is then directed at the specific cause. However, some measures such a low sodium diet, diuretics (‘water pills’) and manually withdrawing the fluid (therapeutic paracentesis) may be undertaken to ease the fluid accumulation. These measures are not necessary for menstrual bloating which is usually temporary. Functional bloating is largely due to unknown factors and therefore the appropriate treatment cannot be decided upon. There is some evidence to suggest that functional bloating, which can even vary in severity within hours, may be due to intestinal gas in certain cases. It is less likely to occur or is minimal in a person with firm abdominal muscles, regular but not excessive bowel movements and in a person who is more active. However, this bloating is not significant if temporary before or during the menstrual periods and does not need to be treated.

Sometimes the acidic stomach contents flows backwards into the esophagus where it cause severe irritation of the delicate inner lining of the esophagus. This acid reflux is felt as a burning chest pain known as heartburn. It is usually acute and can be easily treated and may then never occur again. However, sometimes there is ongoing reflux irrespective of the usual trigger factors. Acid reflux is more correctly known as gastroesophageal reflux disease (GERD), although the latter term is usually used to refer to the more chronic state.

 Causes of Acid Reflux

Acid reflux is the main cause of heartburn but the burning chest pain can sometimes be related to other causes that may not involve the gastrointestinal tract. Heartburn and cardiac pain are often mistaken for one another and it is not uncommon for a person with severe heartburn to present at the emergency room believing that they are having a heart attack. While this is not common in youngerwomen, the risks is nevertheless present and more so in older women and those with a history of heart disease.

Most cases of acid reflux in pregnancy are acute – it arises in pregnancy and resolves soon after childbirth. However, women with a history of reflux, even prior to pregnancy, are likely to experience an exacerbation during pregnancy with the condition persisting after childbirth unless suitable treatment is initiated. Acid reflux is largely due to a dysfunctional lower esophageal sphincter but may also occur with delayed gastric emptying and increased intra-abdominal pressure. In pregnant, the expanding uterus increases the intra-abdominal pressure, pushes against the stomach and the higher than normal levels of female hormones affects normal upper gastrointestinal motility and the functioning of the lower esophageal sphincter.

The condition is more likely to be worse after eating a heavy meal, when lying down or with the intake of alcohol or cigarette smoking, both of which should be stopped during pregnancy. It may also be exacerbated by strenuous physical activity, bending over and with emotional upset.

Symptoms of Acid Reflux

Heartburn is a symptom of acid reflux and not a disease on its own. Other signs and symptoms may be present including :

• Nausea
• Regurgitation
• Upper middle abdominal pain
• Sour taste in the mouth
• Sore throat particularly in the morning that eases during the course of the day.

Sometimes reflux is asymptomatic and is then referred to as silent reflux disease.

Medication for Reflux in Pregnancy

Reflux, like any disease or symptom in pregnancy, should be managed conservatively as far as possible. Dietary change and avoiding trigger factors are the first step that a pregnant women should undertake. Sleeping slightly elevated and avoiding eating for at least 2 to 3 hours before bedtime should also be considered. Never use any antireflux medication without first consulting with a medical practitioner. Some of these medication may have adverse effects in pregnancy. Antacids, sucralfates and H2-antagonists can be used during pregnancy. While proton pump inhibitors may be used, it should utilized cautiously or avoided altogether as with H2-antagonists in the first trimester of pregnancy.

]]> http://www.phaa.com/acid-reflux-gerd-and-heartburn-in-pregnancy.htm/feed 0 http://www.phaa.com/heavy-periods-excessive-menstrual-bleeding.htm http://www.phaa.com/heavy-periods-excessive-menstrual-bleeding.htm#comments Mon, 07 Nov 2011 20:35:36 +0000 Dr. Chris http://www.phaa.com/?p=732 The quantity of blood lost during the monthly periods varies among women. It is estimated to be about 20 to 60ml throughout the menstruation which can vary between 2 to 7 days but averages about 3 to 5 days in most women. Despite these difference, every woman has a fair idea of the usual amount of blood lost as a result of menstrual bleeding. Sometimes this can be excessive in which case it is known as menorrhagia – heavy vaginal bleeding or prolonged vaginal bleeding. An isolated period which is heavier or longer than normal is not a cause for concern but if it persists or is recurrent then it needs to be investigated further as it may be a symptom of some underlying disease.

Causes of a Heavy Period

Heavy menstrual bleeding is a symptom associated with various gynecological disorders, systemic diseases and with the use of certain medication. The presence of other signs and symptoms such as severe menstrual pain, cramping, abnormally large blood clots and any abnormal vaginal discharge should be noted to aid with a diagnosis.

The most common cause of a heavy menstrual bleed is related to hormonal fluctuations. These changes may arise for any number of reasons, either due to underlying gynecological conditions, medication, changes in the body’s physiology or with extreme stress to the system as may be seen after a severe illness. Some of these causes can be transient and may not occur again.

Miscarriage may cause heavy menstrual bleeding. Sometimes a heavy period is experienced by a woman who is not even aware that she is pregnant and is the only symptoms of pregnancy and the subsequent loss of pregnancy. It is the body’s way of expelling the products of conception. Women who are aware of their pregnancy need to be cautious about any bleeding during the first trimester, irrespective of the quantity of blood, as it may be a sign of a threatened abortion or ectopic pregnancy.

Polycystic ovarian syndrome and the start of premature ovarian failure or menopause (perimenopause) may be marked with anovulatory periods. This means that an egg cells is not released from the ovary (anovulation) and can disturb the normal hormonal changes in the menstrual cycle. A heavy period or prolonged period can be a symptom of this disturbance.

Growths in and around the uterus may also cause heavy periods. Uterine fibroids and uterine polyps are benign growths of the uterus. Endometriosis is when the endometrial tissue (inner lining of the uterus) occurs at sites outside of the uterus but usually within the pelvis. The different cancers of the female reproductive tract like ovarian cancer, uterine cancer or cervical cancer very rarely cause excessive vaginal bleeding.

Bleeding disorders are conditions where the normal blood clotting process is affected like in hemophilia or von Willebrand’s disease. This can cause heavy and prolonged menstrual periods.

Medication such as drugs used to alter the hormone levels and anticoagulants specifically may lead to abnormalities of menstrual bleeding. Other medication such as anti-inflammatory drugs may also have this effect. Heavy periods can also occur after using the ‘morning after pill’ (emergency contraceptive) and sometimes after discontinuing birth control pills (oral contraceptive).

Sometimes heavy menstrual bleeding  can be related to other diseases apart from gynecological disorders. This may be seen with thyroid disorders and pelvic inflammatory disease (PID).

Types of Treatment

The type of treatment to be undertaken will depend on :

• General health of the patient.
• Age of the patient.
• Type of cancer.
• The stage of the cancer or the extent of spread at the time of detection.
• Size of the tumor.
• The wish to get pregnant.
• Whether the tumor is hormone dependent.
• Recurrence of cancer.
• Consideration of the side effects of various forms of treatment.

Surgery

Surgery is the mainstay of treatment for most types of female reproductive system cancers. The focus on treatment is to prevent pre-cancerous lesions progressing to invasive cancer. Pre-cancerous lesions may be treated with cold knife conization, laser conization, LEEP, laser vaporization, or cryotherapy. Women who have completed their family may prefer hysterectomy (surgical removal of the uterus). Women with early stage gynecologic cancer are usually treated with hysterectomy.

The types of surgery may include :

• Radical trachelectomy involves removal of the cervix, a portion of the vagina, and the pelvic lymph nodes. This method is preferred for women with small cervical tumors who wish to get pregnant in the future.
• Total hysterectomy is the removal of the uterus and cervix.
• Radical hysterectomy is the removal of the cervix and the tissues around it, uterus, and a portion of the vagina.
• Bilateral salpingo-oophorectomy is the removal of the fallopian tubes and ovaries on both sides. This may be done with total or radical hysterectomy.
• Lymphadenectomy is the removal of the lymph nodes near the tumor and may be done along with hysterectomy.
• Pelvic exenteration is the removal of most of the tissues and organs in the pelvis, including the bladder and rectum, along with radical hysterectomy.

Radiation Therapy

Radiation is a form of high-energy beam which is used to destroy the cancer cells or prevent it from multiplying. There are 2 types of radiation therapy which may be used alone or together. They are external beam radiation therapy, where the radiation is given by a machine from the outside, and internal radiation therapy (brachytherapy), where small devices containing radioactive material are placed near the tumor through the vagina.

Radiotherapy may be used alone or in combination with surgery or chemotherapy. It may be used at any stage of the disease. It is often used for treatment of recurrent cancers or as palliative therapy for giving relief from symptoms where a cure is not possible.

Chemotherapy

Chemotherapy uses anti-cancer drugs such as 5-FU, cisplatin, carboplatin, paclitaxel, and cyclophosphamide to destroy or stop multiplication of cancer cells. A single drug or a combination of drugs may be used, which may be given by mouth or through intravenous injections. Chemotherapy is more commonly used in the late stages of the disease when the cancer has spread to distant sites. It is also used for recurrent cancers and as palliative therapy. Chemotherapy may be used alone or in combination with surgery or radiotherapy.

Hormone Therapy

Hormone-dependent endometrial tumors may be treated with hormone therapy. Hormones or anti-hormones such as progestins, tamoxifen, gonadotropin-releasing hormone (GnRH) agonists, and aromatase inhibitors are used in the treatment of endometrial cancer.

Complications of Treatment

Complications of surgery may include general complications such as bleeding, infection, injury to adjacent tissues and organs such as the bladder and bowel, and anesthetic complications. After hysterectomy, a woman will not get her periods and will not be able to fall pregnant. Premature menopause, with hot flashes and other associated symptoms will occur with removal of the ovaries. Various emotional and sexual problems may arise following surgery. Intercourse may be difficult after treatment for vaginal cancer.

Complications of radiotherapy may include loss of appetite, fatigue, hair loss on treated area, diarrhea, nausea, skin reactions, and reduced white blood cells. Side effects will depend upon the amount of radiation and the site of treatment.

Complications of chemotherapy may include hair loss, tiredness, nausea, vomiting, diarrhea, fertility problems, and mouth and vaginal sores.

Complications of hormone therapy will depend upon the hormone used. Hot flashes, night sweats, weight gain, vaginal dryness, and osteoporosis are common side effects.

There is no guarantee that every pregnancy will go on to full term despite the best efforts of the mother, caregivers and medical professionals. While some factors such as advancing maternal age, generally over 35 years, is known to be associated with a greater risk of miscarriage, there is no sure way of knowing at the outset whether a pregnancy will end with the delivery of a healthy baby or in a miscarriage. Nevertheless, if a miscarriage happens more than once consecutively, it needs to be investigated further.

Reasons for Spontaneous Abortion

The exact reason for a miscarriage cannot always be determined. Intensive investigation is warranted in the event of recurrent spontaneous abortions.  Some of the possible causes of a miscarriage includes :

• Genetic abnormalities, also known as chromosomal abnormalities, are the most common causes of miscarriage with most occurring within the first trimester and less frequently before 24 weeks.
• Various factors, sometimes unknown, may be teratogenic (causes embryo malformation) or mutagenic (causes gene mutation). This can at times be associated with lifestyle factors such as cigarette smoking, alcohol consumption and illicit drug use.
• Structural problems of the uterus, cervix and endocervical canal. This includes uterine fibroids.
• Previous uterine surgery can cause adhesions (scar tissue) which may also complicate the pregnancy and lead to miscarriage. This is known as Asherman’s syndrome. Certain medication may also be a causative factor particularly in an unplanned pregnancy. Surgical and medical factors are known as iatrogenic causes. Read more on drugs that affect pregnancy.
• Infections such as rubella (German measles), toxoplasmosis and Listeria infection.
• Chronic diseases particularly endocrine and gynecological disorders such as polycystic ovary syndrome, thyroid disorders, uncontrolled diabetes mellitus, Cushing syndrome and corpus lutem deficiency which is more often acute. Other conditions such as kidney disease, systemic lupus erythematosus (SLE), severe hypertension, sickle cell anemia and antiphospholipid-antibody syndrome may also be associated with a miscarriage.
• Lifestyle factors including tobacco use, alcohol consumption, illicit substances like cocaine and crack and excessive caffeine intake.
• Psychological and physical stress may also be responsible for a miscarriage.
• Injury to the pregnant uterus may be associated with assault, car accidents, falls or even a high voltage electric shock can also cause a miscarriage depending on the severity of the trauma.

Causes of Brown to Black Vaginal Bleeding

It is important to ascertain whether the bleeding is related to a menstrual bleed or not. The presence of other symptoms like pain, discharge preceding or during the bleed, blood clots or pieces of tissue in the blood are all significant in identifying the most likely cause. Remember that a small quantity of brown blood towards the end of a menstrual period is not abnormal and is just degraded blood (“old blood”) being expelled.

Retained menses is not a common phenomenon. It may be due to the menses being retained with the uterus or even in the vagina. An imperforate hymen is where the hymen fully rather than partially covers the vagina and at the onset of menstruation during puberty (menarche), the menses cannot pass out of the vagina. In older women, cervical stenosis which is narrowing of the cervix (or more correctly the endocervical canal) either obstructs or drastically slows down the exit of menses from the uterus. There are other possibly causes relating to anatomical abnormalities of the uterus, cervix or vagina but these are usually present from birth (congenital).

A miscarriage is a more common cause of brown to black vaginal bleeding. While it is a consideration in every pregnant woman’s mind, not all woman realize that they are pregnant until there is an abnormally heavy bleed particularly when it is laden with large clots or the color varies significantly from the normal menstrual blood. The products of conception are eventually ejected but sometimes it is retained. This is known as a missed abortion and arises when the cervical os does not dilate to allow for the products of conception to pass out. Over time there is a scanty brown to black bleed that is often foul smelling. This symptom is less common with an elective / induced abortion if it is done by a medical professional since the cervix is dilated and the products of conception may be removed with a D and C.

Infections of the vagina, cervix or uterus may cause brown to black vaginal bleeds at the proteolytic enzymes of the bacteria rapidly degrade the blood. These infections may be sexually transmitted like gonorrhea and chlamydia, commonly caused by rectal bacteria like E.coli or due to overgrowth of the naturally occurring bacteria in the vagina (vaginosis). It is typically associated with a foul smelling discharge, pelvic pain with pain during urination and intercourse and sometimes a fever.

Cancer is a fairly common cause of vaginal bleeding that is not related to menses – intermenstrual bleeding. It is, however, not a common cause of brown to black vaginal bleeding. An ulceration of the reproductive tract may cause bleeding and if the outflow is restricted or complicated with pelvic inflammatory disease (infection) then there may be a dark brown to black vaginal bleed usually presenting as spotting.