Abnormal Bleeding

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Abnormal Bleeding
CAPT Mike Hughey, MC, USNR
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Causes of Abnormal Bleeding

• 1. Pregnancy
• 2. Malignancy
• 3. Mechanical Problems
• 4. Hormonal Problems

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Rule out Pregnancy

• Patients of childbearing age with unexplained
  abnormal bleeding should have a pregnancy test

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Rule out Malignancy

• Cervical cancer (Pap)
• Vaginal cancer (Exam)
• Ovarian cancer (Exam)
• Uterine cancer (Endometrial biopsy, but under age
  40, cancer very rare)

Invasive Cancer of the Cervix
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Mechanical Problems
Polyps
Fibroids
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Hormonal Problems

• Anovulation
• Ovulatory bleeding
• Delayed menses

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Clinical Management Evaluation
1. Pregnancy Test 2. CBC (anemia) 3. Recent
negative Pap smear 4. Pelvic exam
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Clinical Management Treatment
BCPs
Bedrest
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Clinical Management MEDEVAC
If BCPs/Bedrest fail to resolve the bleeding and
it is heavy, MEDEVAC is the next step. Surgery
(DC, hysteroscopy, etc.) will be needed. This
is best undertaken in other than operational
settings.
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