Vaginal Bleeding
The type of bleeding eg. heavy menstrual bleeding, intermenstrual or unscheduled, post-coital or postmenopausal bleeding can help identify the most likely cause - bpacnz
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Investigating and managing abnormal vaginal bleeding
Establishing the source of bleeding is an essential first step when assessing women* who present with per vaginum (PV) bleeding. Often the source of bleeding is the uterus, however, bleeding from other parts of the genital tract (e.g. vulva, vagina or cervix) must also be considered. Bleeding from the urinary or gastrointestinal tracts may be mistaken by patients for PV bleeding and should be excluded.
Resources
Non-Pregnant Vaginal Bleeding: Differential Diagnosis, Presentation, Evaluation, and Management
Abnormal vaginal bleeding is a common complaint in the ED and affects approximately 20-30% of women during their reproductive years.1 The presentation of abnormal vaginal bleeding can result from abnormal uterine bleeding (AUB), bleeding from the cervix, or bleeding from the infracervical vaginal structures.
Vaginal Bleeding in the Non-Pregnant Patient
PALM-COEIN for etiologies of vaginal bleeding introduced in 2011 by FIGO (International Federation of Gynecology and Obstetrics) and adopted by ACOG (American College of Obstetricians and Gynecologists): PALM (Structural causes) Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia COEIN (Non-structural causes) Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
CRACKCast E034 – Vaginal Bleeding
This chapter covers a complaint that ranges from mostly benign to life threatening, and covers causes and management.
Vaginal Bleeding in the Non-Pregnant Patient
PALM-COEIN for etiologies of vaginal bleeding introduced in 2011 by FIGO (International Federation of Gynecology and Obstetrics) and adopted by ACOG (American College of Obstetricians and Gynecologists): PALM (Structural causes) Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia COEIN (Non-structural causes) Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women
Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabilization, the etiologies of acute abnormal uterine bleeding should be classified using the PALM–COEIN system.
Abnormal bleeding: Why women should treat it, not tough it out
Sometimes, bleeding that is thought to be coming from the vagina may actually be from the bladder or the bowels... One of the most common causes of bleeding and discharge is cervicitis, an infection that often is triggered by sex.
Bleeding After Sex: What You Need To Know
It affects up to 9% of people at some point during their menstrual years[1]. And in about half of these instances, the bleeding resolves on its own without any kind of medical intervention. Vaginal dryness, which can result from many different hormonal scenarios (including menopause) is one of the more common causes of bleeding after sex...
Emergency Department Management Of Vaginal Bleeding In The Nonpregnant Patient
This issue reviews common causes of abnormal bleeding, including anovulatory, ovulatory, and structural causes in both stable and unstable patients. The approach to abnormal bleeding in the prepubertal girl is also discussed.
Pelvic Pain and Vaginal Bleeding
The differential diagnosis in vaginal bleeding is different for pregnant and non-pregnant patients. In a pregnant patient, determining whether the pregnancy is ectopic is of great importance as it is one of the leading causes of maternal morbidity and mortality in the United States. The date of the patient’s last menstrual period (LMP), the duration of the menses and the amount of bleeding should be obtained in women who present with vaginal bleeding. Normal menstrual blood loss is 20-60 ml per cycle. If blood loss exceeds 80 ml and occurs at irregular intervals, it is termed menometrorrhagia. In neonates, vaginal bleeding may be normal if it occurs within the first 10 days of life and is due to withdrawal from maternal estrogen exposure.
Reasons for Vaginal Bleeding After Sex
Bleeding after vaginal sex may be an initial indication of endometrial or cervical cancer. However, more than likely, the cause is due to another condition.
What causes bleeding between periods?
Some other causes of irregular or abnormal bleeding include: •taking the emergency contraceptive pill •injury or disease of the vagina – for example, from having rough sex, an infection, ulcer or varicose veins •a recent abortion – if you’re bleeding heavily, seek medical advice •sexually transmitted infections (STIs) such as chlamydia – if you’ve recently had unprotected sex with a new partner, it’s a good idea to get tested •reproductive hormones not working normally – this is common in women approaching the menopause or in women with polycystic ovary syndrome (PCOS) •stress •vaginal dryness •harmless changes to the cervix (neck of the womb) – this may be called ectropion or cervical erosion •cervical cancer...
Investigating and managing abnormal vaginal bleeding
Abnormal vaginal bleeding has many potential causes ranging from anovulatory to malignancy.
Life in the Fastlane
Ovulatory abnormal bleeding AKA menorrhagia AKA heavy menstrual bleeding = Heavy or prolonged periods, generally >80mL. Occurs in a cyclic pattern. Anovulatory abnormal bleeding AKA dysfunctional uterine bleeding = Bleeding that is irregular and of variable volume. Occurs in a noncyclic pattern. Related to insufficient progesterone in the absence of a corpus luteum. Common at extremes of reproductive age and in PCOS.
MayoClinic
Abnormal vaginal bleeding can relate to an issue with your reproductive system (a gynecologic condition) or to other medical problems or certain medications. If you've gone through the menopausal transition — 12 consecutive months without a menstrual period — any vaginal bleeding is a particular cause for concern.
MedicineNet
Abnormal vaginal bleeding is a flow of blood from the vagina that occurs either at the wrong time during the month or in inappropriate amounts. In order to determine whether bleeding is abnormal, and its cause, the doctor must consider three questions: Is the woman pregnant? What is the pattern of the bleeding? Is she ovulating?
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