Obstetrics and Gynecology – Abnormal Vaginal Bleeding: By Kate Pulman M.D.

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07/08/23

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Obstetrics and Gynecology – Abnormal Vaginal Bleeding
Whiteboard Animation Transcript
with Kate Pulman, MD
https://medskl.com/Module/Inde....x/abnormal-vaginal-b

Abnormal vaginal bleeding may occur in the following scenarios:

Heavy or prolonged menstrual bleeding,
Intermenstrual bleeding,
Bleeding associated with pregnancy, or
Post-menopausal bleeding.

There are four important circumstances that you cannot afford to miss:

1. Disorders of early pregnancy: all women of reproductive age who present with vaginal bleeding should have a pregnancy test. Bleeding in early pregnancy may occur in the setting of threatened or incomplete abortion, or ectopic pregnancy. Severe hemorrhage from spontaneous pregnancy loss or ectopic pregnancy can be a life-threatening emergency. If your patient is presyncopal, tachycardic, hypotensive, or has severe abdominal pain from hemoperitoneum, they should immediately be assessed in the nearest emergency department.

2. Acute menorrhagia: this most commonly occurs in perimenopausal women. As menstrual cycles become more infrequent, the endometrial lining grows under the influence of estrogen. The irregular shedding of this lining presents as vaginal bleeding, which can become heavy and may persist for several weeks. Because it transpires over many days or weeks, patients can become very anemic and may eventually become symptomatic with lightheadedness and fatigue.

3. Cervical Cancer: All patients with abnormal bleeding should have a pelvic examination. Visualization and palpation of the cervix will allow you to rule out an obvious cervical cancer.

4. Endometrial cancer: An endometrial biopsy is indicated to rule out cancer in the following circumstances:

Any bleeding (including one episode of spotting or pink discharge) in post-menopausal women

Any woman over the age of 40 with abnormal vaginal bleeding

Any woman under the age of 40 with abnormal vaginal bleeding and any risk factor for endometrial cancer. These risk factors include obesity, nulliparity, infertility, family history, anovulation (such as PCOS) or tamoxifen use.