Physiological genital bleeding in a woman is called menstruation. It reflects the changes in the lining of the uterus (endometrium) during an unfulfilled pregnancy. When bleeding occurs unrelated to the menstrual cycle, it is referred to as metrorrhagia. Bleeding outside the menstrual cycle can be a symptom that points to various diseases. They can be benign, such as uterine fibroids, glandular hyperplasia of the endometrium, they can be associated with the appearance of atypical cells – polyps, dysplasias, or they can be malignant – cervical cancer, sarcomas. It is important diagnostically to determine from which part of the genital system the bleeding originates. Other diseases that can occur with bleeding are ovarian cysts, polycystic ovary syndrome, sexually transmitted infections, endometriosis and trauma. In women reaching menopause, periods become irregular as their intervals change. Increased or decreased bleeding is possible. Gradually, the onset of menstruation each month stops. The presence of genital bleeding during menopause always requires consultation with an obstetrician-gynecologist. It can be a symptom of both benign diseases and malignant ones such as neoplasms of the uterine body and cervix. Bleeding is also associated with ectopic pregnancy, miscarriage, and other pregnancy complications. In pregnancy, bleeding is caused by placenta previa, premature detachment of the placenta, or a preexisting umbilical cord. The term dysfunctional uterine bleeding is used in cases of disturbances in the regulatory function of the hypothalamic-pituitary-ovarian axis. They may alternate with periods of absent or scanty menstruation. In the neonatal period, there is such dysfunctional uterine bleeding, which is associated with the so-called hormonal crisis of the newborn – the increased hormones of the mother have an impact on the fetus. This condition is transient and does not require treatment. Amenorrhea Amenorrhea is the absence of menstruation for three consecutive months. The most likely cause of this disorder is pregnancy. Primary amenorrhea is the absence of menstruation in women who have never had one. While secondary amenorrhea is called absence of menstruation when the woman has already had menstruation. NEWS_MORE_BOX A reason that can lead to primary amenorrhea is a disturbance in the hypothalamus-pituitary-ovary axis, that is, a disturbance in hormonal regulation. Another possible reason is underweight, which is characteristic of girls actively engaged in sports. Certain chromosomal abnormalities such as Turner syndrome can also lead to primary amenorrhea. Secondary amenorrhea is observed during pregnancy and lactation as a physiological condition of the woman. Secondary amenorrhea, like primary amenorrhea, can be a consequence of a violation in the hormonal regulation of the monthly cycle or previous surgical removal of the uterus – hysterectomy.This disorder often occurs as a result of stress, and it is characteristic that when the stressful factor is removed, menstruation returns. Less commonly, thyroid and adrenal gland problems cause this type of amenorrhea. Laboratory tests on hormone levels, as well as imaging studies (ultrasound, computed tomography, nuclear magnetic resonance) are used to make the diagnosis. In the event that amenorrhea is the result of pregnancy, this is proven by testing human chorionic gonadotropin (hCG). Treatment is aimed at the cause of the disease. Other diseases that can occur with bleeding are ovarian cysts, polycystic ovary syndrome, sexually transmitted infections, endometriosis and trauma.