Nonpregnant vaginal bleeding: Difference between revisions
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Normal menstruation | *Normal menstruation | ||
*Menorrhagia | **28 + 7 day cycles; 4+ 3 days of bleeding | ||
*Metrorrhagia | *Menorrhagia | ||
*Menometrorrhagia | **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 | *Postmenopausal bleeding: recurrence of bleeding in a menopausal woman 1 year after cessation of cycles | ||
Revision as of 21:34, 22 July 2011
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