Vaginal bleeding

Keywords: Dysfunctional uterine bleeding

Causes

Appropriate Tests

 

Diagnosis based on clinical assessment, including: age of patient, sexual activity, and relationship of bleeding to menstrual cycle.

Consider possibility of miscarriage of pregnancy (including ectopic) in any woman of child bearing age. See under Abortion and Ectopic pregnancy

Cervical cytology in all sexually active patients, and in all patients over 25 years of age.

Full blood count, Blood film if bleeding heavy and/or prolonged.

See Iron deficiency

See also Vaginal discharge

Menorrhagia

 

Uterine/cervical abnormalities, especially

  • Fibroids
  • Polyps
  • Adenomyosis
  • Endometriosis
  • Endometrial hyperplasia
  • Carcinoma

Endometrial pipelle or biopsy (curettage). Lesion biopsy if appropriate.

High, unopposed endogenous oestrogen levels

  • Polycystic ovary syndrome
  • Ovarian tumours

 

See Ovarian mass

Other disorders

  • Renal failure
  • Hypothyroidism
  • Cirrhosis

 

Dysfunctional bleeding

Common; diagnosis of exclusion.

Bleeding disorder

See under Bleeding disorders

Post-coital, intermenstrual bleeding

Endometrial biopsy (curettage); lesion biopsy if appropriate.

Cervical abnormalities, especially

  • Cervical ectropion
  • Cervicitis
  • Carcinoma

See Cervical lesion

Oral contraceptives, especially

  • Progesterone-only preparations

 

Uterine abnormalities

  • Fibroids
  • Intra-uterine contraceptive device
  • Carcinoma

 

Vaginal abnormalities, including

  • Retained tampon

 

See also Vaginal discharge

Post-menopausal bleeding

Hysteroscopic examination and Endometrial biopsy; lesion biopsy if appropriate.

Uterine/cervical abnormalities, especially

  • Carcinoma
  • Sarcoma
  • Polyps
  • Atrophic change