Vaginal bleeding (main)

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Background

  • Undifferentiated vaginal bleeding is normally approached by rapidly determining pregnancy status and, if pregnant, estimated gestation age
  • Subsequent workup is then performed based on these factors

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

Clinical Features

  • Vaginal bleeding

Differential Diagnosis

Vaginal bleeding (main)

Evaluation

Workup

  • Pregnancy test (urine or serum)
  • Hemoglobin (CBC or POC)
  • Consider type & screen

Diagnosis

PALM-COEIN Classification of Vaginal Bleeding[1]

  • PALM: structural causes
    • Polyp (AUB-P)
    • Adenomyosis (AUB-A)
    • Leiomyoma (AUB-L)
    • Malignancy and hyperplasia (AUB-M)
  • COEIN: nonstructural causes
    • Coagulopathy (AUB-C)
    • Ovulatory dysfunction (AUB-O)
    • Endometrial (AUB-E)
    • Iatrogenic (AUB-I)
    • Not yet classified (AUB-N)

Management

See individual pages:

Disposition

  • See individual diagnoses

See Also

Vaginal bleeding (main)

External Links

References

  1. The International Federation of Gynecology and Obstetrics