ABNORMAL UTERINE BLEEDING

Any vaginal bleeding which represents a variation from the normal pattern of regular menstruation.

Causes

  • Hormonal abnormalities (ovulatory dysfunction)
  • Abortion, ectopic pregnancy
  • Uterine diseases (fibroids, polyps etc)
  • Cancers (cervical, uterine, rarely vaginal)
  • Infections (STIs)
  • Others (coagulation disorders etc.)
  • Iatrogenic (IUD, hormonal contraceptives)

Clinical features

  • Abnormal menstrual pattern
  • Continuous or subcontinuous bleeding
  • It can be acute and heavy or light and subcontinuous

Investigations

  • Pregnancy test to exclude abortion and pregnancy
  • Haemoglobin level
  • Vaginal examination (for cervical and vaginal abnormalities e.g. cervical cancer)
  • Abdominal ultrasound

Management

Management is based on the possible cause.

CAUSE/ISSUE TREATMENT
General
measures
Ferrous sulphate or Fefol 1
tablet once or twice a day
Positive
pregnancy test
See section on abortion and
ectopic pregnancy
Bleeding in
postmenopausal
woman
Refer for specialist assessment
(possible endometrial
pathology)
Lesion (ulcer,
growth) in
vagina/on cervix
Refer for specialist assessment
Suspect fibroid
(bulky hard
uterus)
Use analgesics, iron
supplement, refer for
ultrasound scan
Other signs of
infection
Treat as PID and review
Women on
family planning
See sections on FP methods and
side effects