Nonpregnant vaginal bleeding: Difference between revisions

Revision as of 01:28, 20 August 2011

Background

Normal menstruation:
- 28 +/- 7d cycles; 4d of bleeding
Definitions
- Menorrhagia
  - Prolonged (>7d) or excessive (>60mL daily) vaginal bleeding at regular intervals
- Metrorrhagia
  - Irregular vaginal bleeding outside the normal cycle
Menometrorrhagia
- Excessive irregular vaginal bleeding
Postcoital bleeding
- Vaginal bleeding after intercourse, suggesting cervical pathology
Postmenopausal bleeding
- Any bleeding that occurs >6 mo after cessation of menstruation
Dysfunctional uterine bleeding
- Bleeding not due to an organic cause

Diagnosis

Must rule-out:
- Pregnancy
- Trauma
- Bleeding dyscrasia
- Infection
- Retained foreign body

DDX

Systemic Causes

Secondary anovulation
Coagulopathy
1. Von Willebrand, ITP
Hypothyroidism
Hormone replacement therapy
Cirrhosis

Reproductive Tract Causes

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

Work-Up

Urine pregnancy
Hb
Coags (only if h/o or suspect coaulopathy)
?TSH
?Pelvic u/s

Treatment

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

Disposition

D/c home w/ OB/GYN f/u

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Normal menstruation
+*Normal menstruation:
-**28 + 7 day cycles; 4+ 3 days of bleeding
+**28 +/- 7d cycles; 4d of bleeding
-*Menorrhagia
+*Definitions
-**prolonged (>7 days) or excessive (>80mL daily) of uterine bleeding occurring at regular intervals
+**Menorrhagia
-*Metrorrhagia
+***Prolonged (>7d) or excessive (>60mL daily) vaginal bleeding at regular intervals
-**uterine bleeding occurring at irregular and more frequent than normal intervals
+**Metrorrhagia
+***Irregular vaginal bleeding outside the normal cycle
 *Menometrorrhagia
-**prolonged/excessive bleeding occurring at irregular and ore frequent intervals than normal
+**Excessive irregular vaginal bleeding
-*Postmenopausal bleeding
+*Postcoital bleeding
-**recurrence of bleeding in a menopausal woman 1 year after cessation of cycles
+**Vaginal bleeding after intercourse, suggesting cervical pathology
+*Postmenopausal bleeding
+**Any bleeding that occurs >6 mo after cessation of menstruation
+*Dysfunctional uterine bleeding
+**Bleeding not due to an organic cause
+==Diagnosis==
+*Must rule-out:
+**Pregnancy
+**Trauma
+**Bleeding dyscrasia
+**Infection
+**Retained foreign body
 ==DDX==
@@ Line 15: / Line 28: @@
 #Secondary anovulation
 #Coagulopathy
-#Endocrinopathies (Cushings, PCOS, DM, thyroid abnl)
+##Von Willebrand, ITP
+#Hypothyroidism
+#Hormone replacement therapy
 #Cirrhosis
-#Stress/weight gain/excessive diet or exercise
 ===Reproductive Tract Causes===
-#Dysfunctional uterine bleeding
+#Fibroids
-#Ruptured ovarian cyst
+#Adenomyosis
-#Vaginal lac/trauma
+#Endometriosis
+#Neoplasia
+#Infection (vaginitis, PID)
+#Vaginal trauma
 #Foreign Body
 #IUD
-#Uterine fibroids
 #Atrophic endometrium
-#AVM
+#Dysfunctional uterine bleeding
-#Cancer (Endometrial, cervical, vaginal, genital)
+##Diagnosis of exclusion
-#Polyps
+##Ovulatory: Excessive wt change, stress, exercise
-#Endometrial hyperplasia
+##Anovulatory: postmenopause, premenopause, PCOS
-#Infection
-#Lichen sclerosis
-#Urethral prolapse
-#Inflammation (vulvitis, vaginitis, endometritis)
-#Iatrogenic (OCPs, Hormone replacement, psychotropic drugs)
 ==Work-Up==
-# Icon
+#Urine pregnancy
-# Hb
+#Hb
-# ?Orthostatics
+#Coags (only if h/o or suspect coaulopathy)
-# ?IVF/blood
+#?TSH
-# ?CBC
+#?Pelvic u/s
-# ?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)
+#Gyn consult
-# IV estrogen can stop bleeding quickly, consider starting patient on OCPs (speak to GYN first before! may affect EMB results)
+#Estrogen IV/PO (similar efficacy)
-# temporizing bleeding with foley balloon or kerlix soaked in saline and thrombin
+#Temporize bleeding w/ foley balloon or kerlix soaked in saline and thrombin
-# if local bleeding from trauma - suture or silver nitrate
+#Suture or silver nitrate if bleeding from trauma
+==Disposition==
+*D/c home w/ OB/GYN f/u
+==Source==
+Tintinalli
 [[Category:OB/GYN]]