Dysfunctional uterine bleeding: Difference between revisions
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===Severe Bleeding=== | ===Severe Bleeding=== | ||
*Maintain hemodynamics | *Maintain hemodynamics | ||
*Consider IV conjugated estrogen (Premarin) | *Consider IV conjugated estrogen (Premarin) 25mg IV q4-6 hrs until bleeding stops | ||
*Continued severe bleeding requires D&C | *Continued severe bleeding requires D&C | ||
Revision as of 19:26, 18 July 2016
This diagnosis should be used only when all organic causes are ruled-out, which generally does not occur in the ED. See nonpregnant vaginal bleeding for the general approach.
Background
Vaginal bleeding definitions
- Menorrhagia: >7 day (prolonged) or >80 mL/day (excessive) uterine bleeding at regular intervals
- Metrorrhagia: irregular vaginal bleeding outside the normal cycle
- Menometrorrhagia: excessive irregular vaginal bleeding
- Intermenstrual bleeding: variable amounts between regular menstrual periods
- Midcycle spotting: spotting just before ovulation (due to decline in estrogen)
- Polymenorrhea: frequent and light bleeding
- Postcoital bleeding: vaginal bleeding after intercourse, suggesting cervical pathology
- Postmenopausal bleeding: recurrence of bleeding >6 mo after menopause
- Amenorrhea: bleeding that is absent for > 6 months
Workup
- See nonpregnant vaginal bleeding for general approach
- This diagnosis generally requires a endocervical curettage/endometrial biopsy to have been performed
Diagnosis
- Diagnosis of exclusion
Differential Diagnosis
Nonpregnant Vaginal Bleeding
Systemic Causes
- Cirrhosis
- Coagulopathy (Von Willebrand disease, ITP)
- Group A strep vaginitis (prepubertal girls)
- Hormone replacement therapy
- Anticoagulants
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Hypothyroidism
- Polycystic Ovary Syndrome
- Secondary anovulation
Reproductive Tract Causes
- Adenomyosis
- Atrophic endometrium
- Dysfunctional uterine bleeding
- Endometriosis
- Leiomyoma (Fibroid)
- Foreign Body
- Infection (vaginitis, PID)
- IUD
- Neoplasia (especially in women >45 years old or in younger women with other risk factors)
- Vaginal Trauma
Management
Heavy bleeding
- Fluid admin
- Estrogen-progestin OCP until gyn follow up
Severe Bleeding
- Maintain hemodynamics
- Consider IV conjugated estrogen (Premarin) 25mg IV q4-6 hrs until bleeding stops
- Continued severe bleeding requires D&C
References
- UpToDate - Management of Abnormal Uterine Bleeding
- eMedicine - Dysfunctional Uterine Bleeding in Emergency Medicine Treatment & Management