Difference between revisions of "Vaginal Bleeding (Non-Pregnant)"

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**Retained foreign body
**Retained foreign body
**If ruled these out the refer for outpt w/u
**If ruled these out the refer for outpt w/u
*Obtain coags only if suspect bleeding dyscrasia
*Obtain TSH, prolactin levels if suspect endocrine d/o

Revision as of 17:45, 29 October 2013


  • Normal menstruation:
    • 28 +/- 7d cycles; 4d of bleeding


  1. Menorrhagia
    1. Prolonged (>7d) or excessive (>60mL daily) vaginal bleeding at regular intervals
  2. Metrorrhagia
    1. Irregular vaginal bleeding outside the normal cycle
  3. Menometrorrhagia
    1. Excessive irregular vaginal bleeding
  4. Polymenorrhea
    1. Frequent and light bleeding
  5. Postcoital bleeding
    1. Vaginal bleeding after intercourse, suggesting cervical pathology
  6. Postmenopausal bleeding
    1. Any bleeding that occurs >6 mo after cessation of menstruation
  7. Dysfunctional uterine bleeding
    1. Bleeding not due to an organic cause


  • Hemodynamically stable pt in ED must rule-out:
    • Pregnancy
    • Trauma
    • Bleeding dyscrasia
    • Infection
    • Retained foreign body
    • If ruled these out the refer for outpt w/u


Systemic Causes

  1. Secondary anovulation
  2. Coagulopathy
    1. Von Willebrand, ITP
  3. Hypothyroidism
  4. Hormone replacement therapy
  5. Cirrhosis

Reproductive Tract Causes

  1. Fibroids
  2. Adenomyosis
  3. Endometriosis
  4. Neoplasia
  5. Infection (vaginitis, PID)
  6. Vaginal trauma
  7. Foreign Body
  8. IUD
  9. Atrophic endometrium
  10. Dysfunctional uterine bleeding
    1. Diagnosis of exclusion
    2. Ovulatory: Excessive wt change, stress, exercise
    3. Anovulatory: postmenopause, premenopause, PCOS


  1. Urine pregnancy
  2. Hb
  3. Coags (only if h/o or suspect coaulopathy)
  4. ?TSH
  5. ?Pelvic u/s


  1. Gyn consult
  2. Estrogen IV/PO (similar efficacy)
  3. Temporize bleeding w/ foley balloon or kerlix soaked in saline and thrombin
  4. Suture or silver nitrate if bleeding from trauma


  • D/c home w/ OB/GYN f/u



See Also

Vaginal Bleeding (Main)