Nonpregnant vaginal bleeding
Revision as of 00:19, 29 March 2011 by Rossdonaldson1 (talk | contribs)
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