Obstetrics and Gynecology – Abnormal Vaginal Bleeding: By Kate Pulman M.D.

Obstetrics and Gynecology – Abnormal Vaginal Bleeding: By Kate Pulman M.D.


Abnormal vaginal bleeding may occur in the
following scenarios: Heavy or prolonged menstrual bleeding,
Intermenstrual bleeding, Bleeding associated with pregnancy, or
Post-menopausal bleeding. There are four important circumstances that
you cannot afford to miss: Disorders of early pregnancy: all women of
reproductive age who present with vaginal bleeding should have a pregnancy test. Bleeding
in early pregnancy may occur in the setting of threatened or incomplete abortion, or ectopic
pregnancy. Severe hemorrhage from spontaneous pregnancy loss or ectopic pregnancy can be
a life-threatening emergency. If your patient is presyncopal, tachycardic, hypotensive,
or has severe abdominal pain from hemoperitoneum, they should immediately be assessed in the
nearest emergency department. Acute menorrhagia: this most commonly occurs
in perimenopausal women. As menstrual cycles become more infrequent, the endometrial lining
grows under the influence of estrogen. The irregular shedding of this lining presents
as vaginal bleeding, which can become heavy and may persist for several weeks. Because
it transpires over many days or weeks, patients can become very anemic and may eventually
become symptomatic with lightheadedness and fatigue.
Cervical Cancer: All patients with abnormal bleeding should have a pelvic examination.
Visualization and palpation of the cervix will allow you to rule out an obvious cervical
cancer. Endometrial cancer: An endometrial biopsy
is indicated to rule out cancer in the following circumstances:
Any bleeding (including one episode of spotting or pink discharge) in post-menopausal women
Any woman over the age of 40 with abnormal vaginal bleeding
Any woman under the age of 40 with abnormal vaginal bleeding and any risk factor for endometrial
cancer. These risk factors include obesity, nulliparity, infertility, family history,
anovulation (such as PCOS) or tamoxifen use.

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