Vaginal bleeding (main)
Background
- Undifferentiated vaginal bleeding is normally approached by rapidly determining pregnancy status and, if pregnant, estimated gestation age
- Subsequent workup is then performed based on these factors
Vaginal bleeding definitions
- Menorrhagia: >7 day (prolonged) or >80 mL/day (excessive) uterine bleeding at regular intervals
- Metrorrhagia: irregular vaginal bleeding outside the normal cycle
- Menometrorrhagia: excessive irregular vaginal bleeding
- Intermenstrual bleeding: variable amounts between regular menstrual periods
- Midcycle spotting: spotting just before ovulation (due to decline in estrogen)
- Polymenorrhea: frequent and light bleeding
- Postcoital bleeding: vaginal bleeding after intercourse, suggesting cervical pathology
- Postmenopausal bleeding: recurrence of bleeding >6 mo after menopause
Clinical Features
- Vaginal bleeding
Differential Diagnosis
Evaluation
Workup
- Pregnancy test (urine or serum)
- Hemoglobin (CBC or POC)
- Consider type & screen
PALM-COEIN Classification of Vaginal Bleeding[1]
- PALM: structural causes
- Polyp (AUB-P)
- Adenomyosis (AUB-A)
- Leiomyoma (AUB-L)
- Malignancy and hyperplasia (AUB-M)
- COEIN: nonstructural causes
- Coagulopathy (AUB-C)
- Ovulatory dysfunction (AUB-O)
- Endometrial (AUB-E)
- Iatrogenic (AUB-I)
- Not yet classified (AUB-N)
Management
See individual pages:
- Vaginal Bleeding (Non-Pregnant)
- Vaginal Bleeding Pregnant (less than 20wks)
- Vaginal Bleeding Pregnant (greater than 20wks)
- Post-Partum Hemorrhage
- Vaginal bleeding (peds)
Disposition
- See individual diagnoses
See Also
References
- The International Federation of Gynecology and Obstetrics
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