Vaginal Bleeding (Non-Pregnant)

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Definitions

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


Differential

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

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