Vaginal Bleeding (Non-Pregnant)

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

  1. Secondary anovulation
  2. Coagulopathy
  3. Endocrinopathies (Cushings, PCOS, DM, thyroid abnl)
  4. Cirrhosis
  5. Stress/weight gain/excessive diet or exercise

Reproductive Tract Causes

  1. Dysfunctional uterine bleeding
  2. Ruptured ovarian cyst
  3. Vaginal lac/trauma
  4. Foreign Body
  5. IUD
  6. Uterine fibroids
  7. Atrophic endometrium
  8. AVM
  9. Cancer (Endometrial, cervical, vaginal, genital)
  10. Polyps
  11. Endometrial hyperplasia
  12. Infection
  13. Lichen sclerosis
  14. Urethral prolapse
  15. Inflammation (vulvitis, vaginitis, endometritis)
  16. Iatrogenic (OCPs, Hormone replacement, psychotropic drugs)

Work-Up

  1. Icon
  2. Hb
  3.  ?Orthostatics
  4.  ?IVF/blood
  5.  ?CBC
  6.  ?Coags only if h/o or suspect coaulopathy
  7.  ?TSH
  8.  ?pelvic u/s
  9. 2 large bore IV's if unstable

Treatment

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