Nonpregnant vaginal bleeding: Difference between revisions
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== | ==Background== | ||
Normal menstruation: 28 + 7 day cycles; 4+ 3 days of bleeding | 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 | 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) | |||
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 | |||
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== | ==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 | |||
Treatment | |||
[[Category:OB/GYN]] | [[Category:OB/GYN]] |
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