Nonpregnant vaginal bleeding: Difference between revisions

Revision as of 00:19, 29 March 2011

Background

Normal menstruation: 28 + 7 day cycles; 4+ 3 days of bleeding

Menorrhagia: prolonged (>7 days) or excessive (>80mL daily) of uterine bleeding occurring at regular intervals

Metrorrhagia: uterine bleeding occurring at irregular and more frequent than normal intervals

Menometrorrhagia: prolonged/excessive bleeding occurring at irregular and ore frequent intervals than normal

Postmenopausal bleeding: recurrence of bleeding in a menopausal woman 1 year after cessation of cycles

DDX

Systemic Causes

Secondary anovulation
Coagulopathy
Endocrinopathies (Cushings, PCOS, DM, thyroid abnl)
Cirrhosis
Stress/weight gain/excessive diet or exercise

Reproductive Tract Causes

Dysfunctional uterine bleeding
Ruptured ovarian cyst
Vaginal lac/trauma
Foreign Body
IUD
Uterine fibroids
Atrophic endometrium
AVM
Cancer (Endometrial, cervical, vaginal, genital)
Polyps
Endometrial hyperplasia
Infection
Lichen sclerosis
Urethral prolapse
Inflammation (vulvitis, vaginitis, endometritis)
Iatrogenic (OCPs, Hormone replacement, psychotropic drugs)

Work-Up

Icon
Hb
?Orthostatics
?IVF/blood
?CBC
?Coags only if h/o or suspect coaulopathy
?TSH
?pelvic u/s
2 large bore IV's if unstable

Treatment

gyn consult (emergently if unstable)
IV estrogen can stop bleeding quickly, consider starting patient on OCPs (speak to GYN first before! may affect EMB results)
temporizing bleeding with foley balloon or kerlix soaked in saline and thrombin
if local bleeding from trauma - suture or silver nitrate

Authors:

@@ Line 1: / Line 1: @@
-==Definitions==
+==Background==
 Normal menstruation: 28 + 7 day cycles; 4+ 3 days of bleeding
@@ Line 12: / Line 10: @@
 Postmenopausal bleeding: recurrence of bleeding in a menopausal woman 1 year after cessation of cycles
+==DDX==
+===Systemic Causes===
-==Differential==
+#Secondary anovulation
+#Coagulopathy
+#Endocrinopathies (Cushings, PCOS, DM, thyroid abnl)
-Systemic Causes:
+#Cirrhosis
+#Stress/weight gain/excessive diet or exercise
-Secondary anovulation
-Coagulopathy
-Endocrinopathies (Cushings, PCOS, DM, thyroid abnl)
-Cirrhosis
-Stress/weight gain/excessive diet or exercise
-Reproductive Tract Causes:
-Dysfunctional uterine bleeding
-Ruptured ovarian cyst
-Vaginal lac/trauma
-Foreign Body
-IUD
-Uterine fibroids
-Atrophic endometrium
-AVM
-Cancer (Endometrial, cervical, vaginal, genital)
-Polyps
-Endometrial hyperplasia
+===Reproductive Tract Causes===
+#Dysfunctional uterine bleeding
-Infection
+#Ruptured ovarian cyst
+#Vaginal lac/trauma
-Lichen sclerosis
+#Foreign Body
+#IUD
-Urethral prolapse
+#Uterine fibroids
+#Atrophic endometrium
-Inflammation (vulvitis, vaginitis, endometritis)
+#AVM
+#Cancer (Endometrial, cervical, vaginal, genital)
-Iatrogenic (OCPs, Hormone replacement, psychotropic drugs)
+#Polyps
+#Endometrial hyperplasia
+#Infection
+#Lichen sclerosis
+#Urethral prolapse
+#Inflammation (vulvitis, vaginitis, endometritis)
+#Iatrogenic (OCPs, Hormone replacement, psychotropic drugs)
 ==Work-Up==
+# Icon
+# Hb
+# ?Orthostatics
+# ?IVF/blood
+# ?CBC
+# ?Coags only if h/o or suspect coaulopathy
+# ?TSH
+# ?pelvic u/s
+# 2 large bore IV's if unstable
+==Treatment==
-)  Icon
+# gyn consult (emergently if unstable)
+# IV estrogen can stop bleeding quickly, consider starting patient on OCPs (speak to GYN first before! may affect EMB results)
-)  Hb
+# temporizing bleeding with foley balloon or kerlix soaked in saline and thrombin
+# if local bleeding from trauma - suture or silver nitrate
-)  ?Orthostatics
-)  ?IVF/blood
-)  ?CBC
-)  ?Coags only if h/o or suspect coaulopathy
-)  ?TSH
-)  ?pelvic u/s
-) 2 large bore IV's if unstable
-Treatment
-) gyn consult (emergently if unstable)
-) IV estrogen can stop bleeding quickly, consider starting patient on OCPs (speak to GYN first before! may affect EMB results)
-) temporizing bleeding with foley balloon or kerlix soaked in saline and thrombin
-) if local bleeding from trauma - suture or silver nitrate
 [[Category:OB/GYN]]