Abnormal
uterine bleeding
Inter-menstrual
Post-coital
Post-menopausal
Definition
Bleeding between menses
Aetiology
Clinical presentation
Bleeding (spotting or large bleed, clots)
Diagnosis
Management
Drugs
IUD
Hormonal contraception
Neoplastic
Ectropion
Cervical cancer*
Cervical polyps
Infection/inflammation
STI e.g. chlamydia*
Cervicitis, vaginitis
Endocrine
Pregnancy
History
PC/HPC: bleeds, pain, weight loss
PGH: known gynae, menses, contraception, STIs, smears
POH: gravidy/parity, births, complications
PMH/PSH: clotting/endocrine disorder, abdo surgery
DH: anticoagulants, allergies
FH: gynae conditions, cancers
SH: occupation, smoking, alcohol, ADLs
Examination
Abdo: masses (cancer), tenderness (PID)
Pelvic: masses (cancer), tenderness (PID)
Speculum: ectropion, cervical Ca, cervicitis/vaginitis
Investigations
Bedside: obs (infection)
Urine: pregnancy test
Swabs: HVS and endocervical (STIs), cytology (cancer)
Bloods: FBC (anaemia), CRP (infection), BBV screen (STIs), U+Es, LFTs, clotting
Imaging: TV USS (masses), hysteroscopy and biopsy (masses)
Conservative
Treat cause
Info and advice
Medical
Abx (STI)
Surgical
Excision of polyps, cancer
Aetiology
Clinical presentation
Spotting after SI
Definition
Bleeding after sex
Diagnosis
Neoplastic
Cervical/vaginal/endometrial ca*
Polyps
Infection/inflammation
Cervicitis/vaginitis (STI)*
Trauma
Cervical/vaginal trauma
Management
History
PC/HPC: bleeds, pain, weight loss
PGH: known gynae, menses, contraception, STIs, smears
POH: gravidy/parity, births, complications
PMH/PSH: clotting/endocrine disorder, abdo surgery
DH: anticoagulants, allergies
FH: gynae conditions, cancers
SH: occupation, smoking, alcohol, ADLs
Examination
Abdo: masses (cancer), tenderness (PID)
Pelvic: masses (cancer), tenderness (PID)
Speculum: ectropion, cervical Ca, cervicitis/vaginitis
Investigations
Bedside: obs (infection)
Swabs: HVS and endocervical (STIs), cytology (cancer)
Bloods: FBC (anaemia), CRP (infection), BBV screen (STIs), U+Es, LFTs, clotting
Imaging: TV USS (masses), hysteroscopy and biopsy (masses)
Conservative
Identify cause
Information and advice
Medical
Abx (STI)
Surgical
Excision (polpys, cancer)
Clinical presentation
Bleeding after menopause
Diagnosis
Aetiology
Management
Definition
Bleeding after cessation of menses
Trauma
Cervix/vagina
Neoplastic
Endometrial ca*
Vulval/cervical ca
Ovarian ca
Polyps
Infection/inflammation
Atrophic vaginitis
Cervicitis/vaginitis (STI)
Drugs
Oestrogen withdrawal (HRT)
Investigations
Bedside: obs (infection)
Swabs: HVS and endocervical (STIs), cytology (cancer)
Bloods: FBC (anaemia), CRP (infection), BBV screen (STIs), U+Es, LFTs, clotting
Imaging: TV USS (masses), hysteroscopy and biopsy (masses)
Examination
Abdo: masses (cancer), tenderness (PID)
Pelvic: masses (cancer), tenderness (PID)
Speculum: ectropion, cervical Ca, cervicitis/vaginitis
History
PC/HPC: bleeds, pain, weight loss
PGH: known gynae, menses, contraception, STIs, smears
POH: gravidy/parity, births, complications
PMH/PSH: clotting/endocrine disorder, abdo surgery
DH: anticoagulants, allergies
FH: gynae conditions, cancers
SH: occupation, smoking, alcohol, ADLs
Medical
Abx (STI)
Surgical
Excision (polpys, cancer)
Conservative
Identify cause
Information and advice