Dysfunctional uterine bleeding: Difference between revisions
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''"Dysfunctional uterine bleeding" should only be diagnosed when all organic causes are ruled-out and generally should not be an ED diagnosis. See [[nonpregnant vaginal bleeding]] for the general approach to vaginal bleeding in non-pregnant women.'' | |||
==Background== | ==Background== | ||
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==Workup== | ==Workup== | ||
* | *See [[nonpregnant vaginal bleeding]] for general approach | ||
* | *This diagnosis generally requires a endocervical curettage/endometrial biopsy to have been performed | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Treatment== | ==Treatment== | ||
===Heavy bleeding=== | |||
**Fluid admin | **Fluid admin | ||
**Estrogen-progestin OCP until gyn f/u | **Estrogen-progestin OCP until gyn f/u | ||
===Severe Bleeding=== | |||
**Maintain hemodynamics | **Maintain hemodynamics | ||
**Consider IV conjugated estrogen (Premarin) 25 mg IV q4-6 hrs until bleeding stops | **Consider IV conjugated estrogen (Premarin) 25 mg IV q4-6 hrs until bleeding stops | ||
Revision as of 21:32, 19 February 2015
"Dysfunctional uterine bleeding" should only be diagnosed when all organic causes are ruled-out and generally should not be an ED diagnosis. See nonpregnant vaginal bleeding for the general approach to vaginal bleeding in non-pregnant women.
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
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
Treatment
Heavy bleeding
- Fluid admin
- Estrogen-progestin OCP until gyn f/u
Severe Bleeding
- Maintain hemodynamics
- Consider IV conjugated estrogen (Premarin) 25 mg IV q4-6 hrs until bleeding stops
- Continued severe bleeding requires D&C
Sources
- UpToDate - Management of Abnormal Uterine Bleeding
- eMedicine - Dysfunctional Uterine Bleeding in Emergency Medicine Treatment & Management