Dysfunctional uterine bleeding
Revision as of 21:22, 19 February 2015 by Rossdonaldson1 (talk | contribs)
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
- R/o pregnancy, CBC, TSH
- Coags if suspected liver disease or other coagulopathy
- Pelvic US
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 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