Nonpregnant vaginal bleeding: Difference between revisions

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==Background==
==Background==
*This page is for the generalized approach to undifferentiated vaginal bleeding in non-pregnant women
*Normal menstruation:
*Normal menstruation:
**28 +/- 7d cycles; 4d of bleeding  
**28 +/- 7 day cycles
**4 days of bleeding  


{{Vaginal bleeding definitions}}
{{Vaginal bleeding definitions}}

Revision as of 21:46, 19 February 2015

Background

  • This page is for the generalized approach to undifferentiated vaginal bleeding in non-pregnant women
  • Normal menstruation:
    • 28 +/- 7 day cycles
    • 4 days of bleeding

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

Diagnosis

  • 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

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

Reproductive Tract Causes

Work-Up

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

Treatment

  • Iron supplements
  • Ibuprofen
    • For cramps and theoretically decreases intra-uterine bleeding
  • Hormones
    • Give only if endocervical curettage/endometrial biopsy does not need to be performed (young patient) or has already been performed, as they may alter test results
    • Medroxyprogesterone
      • 150mg IM x 1 then 20mg PO Q8hrs x 3 days
      • In a trial of 48 patients all had cessation in 5 days.[1]
    • Estrogen IV/PO (similar efficacy)

Life Threatening

  • Give blood transfusion
    • O-negative blood if emergent
    • Establish good access
  • Temporize bleeding w/ foley balloon or kerlix soaked in saline and thrombin
  • Suture or silver nitrate if bleeding from trauma

Disposition

  • Most can be discharged home with OB/GYN follow-up
  • For severe anemia or persistent exceedingly heavy flow, consider admission and/or discussion with OB/GYN

Source

  1. Ammerman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013. 208(6):499.e1-e5.

See Also

Vaginal Bleeding (Main)