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