Dysfunctional uterine bleeding

This diagnosis should be used only when all organic causes are ruled-out, which generally does not occur in the ED. See nonpregnant vaginal bleeding for the general approach.

Background

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
  • Amenorrhea: bleeding that is absent for > 6 months

Clinical Features

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

Reproductive Tract Causes

Evaluation

  • See nonpregnant vaginal bleeding for general approach
  • This diagnosis generally requires a endocervical curettage/endometrial biopsy to have been performed

Management

Heavy bleeding

  • Fluid admin
  • Estrogen-progestin OCP until gyn follow up

Severe Bleeding

  • Maintain hemodynamics
  • Consider IV conjugated estrogen (Premarin) 25mg IV q4-6 hrs until bleeding stops
  • Continued severe bleeding requires D&C

References