Carcinoma of the cervix is more common in women over 30. Bleeding is one of the first
symptoms and it typically occurs in between periods. Bleeding may also be noticed after coitus,
severe exertion or straining for defecation. The contact bleeding after coitus or pelvic
examination is especially characteristic. Unfortunately, when bleeding does occur, the disease is
already quite advanced.
Other symptoms may include a blood-tinged vaginal discharge and bladder irritability. The three
symptoms and signs of sacral pain, unilateral lymphoedema and unilateral ureteral obstruction
indicate a very advanced stage of the condition.
Endometriosis
Endometriosis has already been described in the chapter on "Dysmenorrhoea" (Chapter 31).
Symptoms include painful periods with the pain radiating to the rectum or perineum,
menorrhagia and dyspareunia (pain on intercourse).
Carcinoma of the Uterus
Carcinoma of the uterus usually occurs after menopause with roughly 75% of women being
post-menopausal, 15% perimenopausal and 10% still menstruating. This disease seems to be
more common in women who have no children or only one child.
Abnormal uterine bleeding is the most important symptom of this disease often with a bloody
vaginal discharge. In fact, this type of discharge and bleeding in a woman after the menopause
should always be investigated and diagnosed by a gynaecologist and never treated as just
functional bleeding.
Myomas
Myomas are the most common cause of prolonged or excessive menstrual bleeding. They are
usually painless and a mass would only be felt if the myoma is quite large.
Endometrial Polyps
Endometrial polyps cause bleeding only when they protrude into the cervical canal. The bleeding
usually occurs in between periods and is scanty.