Abnormal Vaginal Bleeding
Normal
Age: 9-56
Pattern (cycle): 21-35 days
Amount: 1d - 1w; 30-80ml
Pain: Around cycle
NOTE: Primary amenorrhoea is defined as absence of periods after 15y
DDx
Medical
Hormonal
Local Tissue
Investigations
Bloods (FBC, Fe, Coags, TFT)
US
Hysteroscopy
D&C
Pipelle (endometrial suction)
Mx
Symptomatic:
Hormonal: oestrogen, progesterone/ mirena, topical oestrogen (atrophic)
Surgical: Hysterectomy, endometrial ablation
NOTE: Progesterone side effects = bloating, weight gain,
Source
Dr Amanda Dennis 2014
Age: 9-56
Pattern (cycle): 21-35 days
Amount: 1d - 1w; 30-80ml
Pain: Around cycle
NOTE: Primary amenorrhoea is defined as absence of periods after 15y
DDx
Medical
- Bleeding disorders
- Hyperthyroidism
Hormonal
- Anovulastory cycles (thin endometrium --> progesterone/ oestrogen)
- Menopause
Local Tissue
- Adenomyosis
- Fibroids
- Cysts (endometrial, ovarian)
- Malignancy (ovarian, endometrial, cervical)
- Atrophic vaginitis (common)
- Dysfunctional uterine bleeding (mx: tranexamic acid) --> dx of exclusion
Investigations
Bloods (FBC, Fe, Coags, TFT)
US
Hysteroscopy
D&C
Pipelle (endometrial suction)
Mx
Symptomatic:
Hormonal: oestrogen, progesterone/ mirena, topical oestrogen (atrophic)
Surgical: Hysterectomy, endometrial ablation
NOTE: Progesterone side effects = bloating, weight gain,
Source
Dr Amanda Dennis 2014