Vaginal bleeding (main)

Background

• Undifferentiated vaginal bleeding is normally approached by rapidly determining pregnancy status and, if pregnant, estimated gestation age
• Subsequent workup is then performed based on these factors

Vaginal bleeding definitions

• Menorrhagia: >7 day (prolonged) or >80 mL/day (excessive) uterine bleeding at regular intervals
• Metrorrhagia: irregular vaginal bleeding outside the normal cycle
• Menometrorrhagia: excessive irregular vaginal bleeding
• Intermenstrual bleeding: variable amounts between regular menstrual periods
• Midcycle spotting: spotting just before ovulation (due to decline in estrogen)
• Polymenorrhea: frequent and light bleeding
• Postcoital bleeding: vaginal bleeding after intercourse, suggesting cervical pathology
• Postmenopausal bleeding: recurrence of bleeding >6 mo after menopause
• Amenorrhea: bleeding that is absent for > 6 months

Clinical Features

• Vaginal bleeding

Differential Diagnosis

Vaginal bleeding (main)

• Non-pregnant vaginal bleeding
  • Prepubertal vaginal bleeding
• Pregnant
  • Vaginal bleeding in pregnancy (less than 20wks)
  • Vaginal bleeding in pregnancy (greater than 20wks)
  • Postpartum hemorrhage

Evaluation

Workup

• Pregnancy test (urine or serum)
• Hemoglobin (CBC or POC)
• Consider type & screen

Diagnosis

See individual pages:

• Vaginal Bleeding (Non-Pregnant)
• Vaginal Bleeding Pregnant (less than 20wks)
• Vaginal Bleeding Pregnant (greater than 20wks)
• Post-Partum Hemorrhage
• Vaginal bleeding (peds)

See Also

• Vaginal bleeding (peds)
• Non-pregnant vaginal bleeding
• Prepubertal vaginal bleeding