Dysfunctional uterine bleeding

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Terms

  • Menorrhagia - > 7 d (prolonged) or > 80 ml/d (excessive) uterine bleeding; regular intervals
  • Metrorrhagia - irregular intervals, more frequent than nl bleeding
  • Menometrorrhagia - Prolonged or excessive; irregular intervals
  • Intermenstrual bleeding - variable amounts between regular menstrual periods
  • Midcycle spotting - spotting just before ovulation (due to decline in estrogen)
  • Postmenopausal bleeding - recurrence of bleeding after menopause

Workup

  • R/o pregnancy, CBC, TSH
  • Coags if suspected liver disease or other coagulopathy
  • Pelvic US

Treatment

  • Heavy bleed
    • Fluid admin
    • Estrogen-progestin OCP until gyn f/u
  • Severe
    • 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

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