Abnormal Bleeding PV
Common complaint in the out
patient dept
Normal menstrual loss- 80 ml
• Menorrhagia- normal cycle- increased bleeding,
prolonged or excessive
• Polymennorrhea- short cycles, normal bleeding
• Poly menorrhagia- short cycles, increased
bleeding
• Metrorrhagia- loss of cyclicity- irregular bleeding
• Metropathia haemorrhagica- amenorrhoea
followed by prolonged bleeding
Case scenario 1
• 15 year old with bleeding pv for 1 month
• History?
• Examn?
• Investigations?
History
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Menarche
Menstrual history
LMP
PMP
Amount of blood flow- clots?
Pain
Bleeding gums/elsewhere
Fever
Weight gain/loss
Headache/ visual disturbances
Physical exam
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Built
Anaemia
Hirsuitism
Goitre
Galactorrhoea
Mass in the abdomen
P/R
Investigations
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Hb
BT
CT
Platelet count
Peripheral smear
TFT
ESR
Urine sugar
Treatment
• Haematinics
• Underlying cause if any
• Progesterone to control bleeding- 20-30
mg for 3 days
• Cyclical hormone treatment
Case 2
• 28 year old with increased bleeding pv for
15 days
• History
• Physical exam
• Ix
History
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Menstrual history
Obstetric history- include MTP
Contraceptive use
Dysmenorrhoea
Discharge pv
Fever/ bleeding tendency/ cough/
hypothyroidism
• Post coital bleeding/ irregular spotting
Physical exam
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Anaemia
Goitre
P/vVisualise cervix- look for erosion,
cervicitis, Ca , Polyps, vaginitis
• Look at size of uterus, uniformly
enlarged?, mass in fornices, tenderness
Investigations
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Hb, Tc Dc ESR
Urine sugar
? Urine beta Hcg
USS if needed
Pap smear
Treatment
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If suspicion of pregnancy, USS/ D&C
Attend to cervical lesions if any
Treat polyps with polypectomy
Proper use of contraceptives
If no organic lesion
EACA, Tranexamic acid
Mefenamic acid
Menstrual calender
haematinics