Non-Pregnant Vaginal Bleeding

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 * NBME Shelf Review: OBGYN (EM Clerkship)* Non-Pregnant Vaginal Bleeding (WikiEM)