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Common Causes

  • Structural
    • Cancer
    • Post-menopausal bleeding is cancer until proven otherwise
    • Fibroids
    • Adenomyosis
    • Polyps
  • Coagulopathy
    • Present in approximately 20% of non-pregnant vaginal bleeding
    • Most common = Von Willebrand Disease
  • Hormonal causes
    • Dysfunctional uterine bleeding

Basic Approach to Non-Pregnant Vaginal Bleeding

  • Step 1: Pelvic exam
    • The utility of this is debated
    • It is best to sound thorough on your clerkship
    • Have a chaperone present and document this (include the chaperones name)
  • Step 2: Obtain Labs
    • CBC
      • Anemia?
      • Thrombocytopenia?
    • Coags
      • aPTT is prolonged in 50% of patients with Von Willebrand Disease!
    • Thyroid (TSH)
      • Can be obtained outpatient
      • Common cause of hormonal related vaginal bleeding
  • Step 3: Pelvic ultrasound
    • Evaluates for ANATOMIC causes of vaginal bleeding
  • Step 4: NSAIDS
    • This treats both abdominal pain/cramping
    • Also improves bleeding
  • Step 5: Oral contraceptive pills
    • Can be started on an outpatient basis
    • Useful in patients with hormonal/dysfunctional uterine bleeding
      • Stabilizes endometrial lining

Additional Reading