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Abnormal Bleeding PV. Common complaint in the out patient dept. Normal menstrual loss- 80 ml. Menorrhagia- normal cycle- increased bleeding, prolonged or excessive Polymennorrhea- short cycles, normal bleeding Poly menorrhagia- short cycles, increased bleeding

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abnormal bleeding pv

Abnormal Bleeding PV

Common complaint in the out patient dept

normal menstrual loss 80 ml
Normal menstrual loss- 80 ml
  • Menorrhagia- normal cycle- increased bleeding, prolonged or excessive
  • Polymennorrhea- short cycles, normal bleeding
  • Poly menorrhagia- short cycles, increased bleeding
  • Metrorrhagia- loss of cyclicity- irregular bleeding
  • Metropathia haemorrhagica- amenorrhoea followed by prolonged bleeding
case scenario 1
Case scenario 1
  • 15 year old with bleeding pv for 1 month
  • History?
  • Examn?
  • Investigations?
history
History
  • Menarche
  • Menstrual history
  • LMP
  • PMP
  • Amount of blood flow- clots?
  • Pain
  • Bleeding gums/elsewhere
  • Fever
  • Weight gain/loss
  • Headache/ visual disturbances
physical exam
Physical exam
  • Built
  • Anaemia
  • Hirsuitism
  • Goitre
  • Galactorrhoea
  • Mass in the abdomen
  • P/R
investigations
Investigations
  • Hb
  • BT
  • CT
  • Platelet count
  • Peripheral smear
  • TFT
  • ESR
  • Urine sugar
treatment
Treatment
  • Haematinics
  • Underlying cause if any
  • Progesterone to control bleeding- 20-30 mg for 3 days
  • Cyclical hormone treatment
case 2
Case 2
  • 28 year old with increased bleeding pv for 15 days
  • History
  • Physical exam
  • Ix
history9
History
  • Menstrual history
  • Obstetric history- include MTP
  • Contraceptive use
  • Dysmenorrhoea
  • Discharge pv
  • Fever/ bleeding tendency/ cough/ hypothyroidism
  • Post coital bleeding/ irregular spotting
physical exam10
Physical exam
  • Anaemia
  • Goitre
  • P/v-
  • Visualise cervix- look for erosion, cervicitis, Ca , Polyps, vaginitis
  • Look at size of uterus, uniformly enlarged?, mass in fornices, tenderness
investigations11
Investigations
  • Hb, Tc Dc ESR
  • Urine sugar
  • ? Urine beta Hcg
  • USS if needed
  • Pap smear
treatment12
Treatment
  • If suspicion of pregnancy, USS/ D&C
  • Attend to cervical lesions if any
  • Treat polyps with polypectomy
  • Proper use of contraceptives
  • If no organic lesion
  • EACA, Tranexamic acid
  • Mefenamic acid
  • Menstrual calender
  • haematinics