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.


Normal female anatomy with uterus highlighted.
Diagram of uterine blood supply.

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

  • The patient will not report bleeding amounts in mL/day so knowing the capacities of products is useful:
    • One Light tampon holds ~3mL
    • One Super tampon holds ~10-12mL
    • One Maxi pad holds up to 20-25mL

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

Reproductive Tract Causes


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


Heavy bleeding

  • Fluid administration
  • Estrogen-progestin OCP until gyn follow up - Preferred approach for most patients
  • Contraindications to Estrogen-progestin OCP:
    • Age greater than 35 years
    • Heavy tobacco use;Hypertension
    • History of CVA or ischemic heart disease
    • SLE
    • Migraines with Aura
  • TXA (Tranexamic acid) FDA approved for heavy menstrual bleeding. 1300mg (two 650mg tabs) PO TID[1]

Severe Bleeding

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

See Also

External Links


  1. PMID: 29477633 DOI: 10.1016/j.contraception.2018.02.008