1 / 11

IRREGULAR VAGINAL BLEEDING in a WOMAN BEFORE MENOPAUSE

Max Brinsmead PhD FRANZCOG July 2010. IRREGULAR VAGINAL BLEEDING in a WOMAN BEFORE MENOPAUSE . The common causes are…. Pregnancy-related Successful but threatening to miscarry Unsuccessful & aborting Retained products of conception After normal pregnancy or miscarriage Ectopic

rumer
Download Presentation

IRREGULAR VAGINAL BLEEDING in a WOMAN BEFORE MENOPAUSE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Max Brinsmead PhD FRANZCOG July 2010 IRREGULAR VAGINAL BLEEDING in a WOMAN BEFORE MENOPAUSE

  2. The common causes are… • Pregnancy-related • Successful but threatening to miscarry • Unsuccessful & aborting • Retained products of conception • After normal pregnancy or miscarriage • Ectopic • Cervical Bleeding • Benign • Ectropion, Cervicitis or Polyp • Cancer of the cervix • Bleeding from the uterine cavity • Benign • Fibroids and Polyps • Cancer • Dysfunctional uterine bleeding

  3. But also keep in mind… • Hormones that have been given • Depoprovera (or DMP or DMPA) • Oral contraceptives (COC) • Other • Bleeding disorders • Rare • Usually associated with other bleeding or bruising

  4. When a patient complains about abnormal vaginal bleeding... • First determine if she has: • Regular but heavy or prolonged periods • This is called menorrhagia • It is a common manifestation of fibroids • Rarely due to a bleeding disorder • Regular periods with bleeding at other times • If the bleeding is postcoital it should be regarded as cancer of the cervix until proven otherwise • Irregular bleeding • This may be dysfunctional uterine bleeding but this diagnosis is usually only made when other causes are excluded • And always exclude pregnancy • Best done by pregnancy test

  5. Consider your patient’s age… • If the patient is young (<35 years) • Cancer is uncommon • If the patient is very young & never sexually active • Pregnancy, STD and Ca cervix never occurs • But dysfunctional uterine bleeding is not uncommon • If the patient is >40 years • Cancer from within the uterine cavity can only be excluded by endometrial biopsy or curette • But dysfunctional bleeding is not uncommon

  6. You must always examine… • Look for signs of anaemia • Examine the abdomen to see if there is a uterus or other mass arising out of the pelvis • Pass a speculum and decide if the bleeding is coming from or through the cervix • Examine the pelvis bimanually to see if the uterus is enlarged • (And if the cervix feels normal if it looked abnormal)

  7. Dysfunctional Uterine Bleeding (DUB) • Often a history of missed periods or irregular cycles • May be associated with obesity and hirsutism (PCO Disorder) • Bleeding is usually painless unless there is clot colic • Bleeding can be very heavy or quite prolonged • There is a normal cervix and the uterus is not enlarged

  8. Management of Abnormal Vaginal Bleeding • Antibiotics have no place nor role • Bleeding from an abnormal cervix is rarely a life-threatening emergency but it requires referral for further testing and treatment • Transfusion should be reserved for those with severe anaemia and in whom you cannot immediately control the bleeding • Uterine bleeding after the age of 40 requires referral for D&C • Dysfunctional uterine bleeding can be treated with Pills

  9. Management of Dysfunctional Uterine Bleeding • Bleeding can be controlled with Norethisterone (5 mg tablets) • Give 2 tablets every 2 – 3 hours until the bleeding slows or stops • Then 5 mg BD for 10 – 14 days • The patient can then expect a “normal period” a few days after stopping the pills • Give COC in the next cycle • or Norethisterone 5 mg BD from day 10 – 25 of each cycle for 4 – 6 months • Give iron & folate to treat anaemia

  10. Emergency treatment of any Endometrial Bleeding • When the blood is coming through the cervix • Even if the patient is >40 years • Or if the uterus is enlarged by adenomyosis or fibroids • Or the patient has a bleeding disorder • You can try Norethisterone 10 mg every 2 – 3 hours • But refer also for further Ix and Rx

  11. Management of Hormone-related PV bleeding • Irregular PV bleeding with Depoprovera or COC is secondary to their effect on the endometrium • But make sure that the cervix is normal • Then try Norethisterone as per DUB regimen • Or give Premarin 1.25 mg 8 hourly • Or any COC one tablet 6 hourly • Or just give another injection of Depoprovera

More Related