Nonpregnant vaginal bleeding - Revision history

Rossdonaldson1: /* Work-Up */

2025-02-26T22:36:27Z

Work-Up

← Older revision		Revision as of 22:36, 26 February 2025
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	*Urine pregnancy		*Urine pregnancy
	*Complete blood count		*Complete blood count
	*Coags (if history of or suspect coagulopathy)		*[[Coags]] (if history of or suspect coagulopathy)
	*[[TSH]], prolactin (if suspect endocrine disorder)		*[[TSH]], prolactin (if suspect endocrine disorder)
	*[[C. trachomatis]] and [[N. gonorrhoeae]] testing if risk of infection (consider with post-coital bleeding)		*[[C. trachomatis]] and [[N. gonorrhoeae]] testing if risk of infection (consider with post-coital bleeding)

2025-02-26T22:35:42Z

Work-Up

← Older revision		Revision as of 22:35, 26 February 2025
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	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
	*[[Urine pregnancy]]		*Urine pregnancy
	*Complete blood count		*Complete blood count
	*Coags (if history of or suspect coagulopathy)		*Coags (if history of or suspect coagulopathy)

2025-02-26T22:33:12Z

Work-Up

← Older revision		Revision as of 22:33, 26 February 2025
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	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
	*Urine pregnancy		*[[Urine pregnancy]]
	*Complete blood count		*Complete blood count
	*Coags (if history of or suspect coagulopathy)		*Coags (if history of or suspect coagulopathy)
	*TSH, prolactin (if suspect endocrine disorder)		*[[TSH]], prolactin (if suspect endocrine disorder)
	*C. trachomatis and N. gonorrhoeae testing if risk of infection (consider with post-coital bleeding)		*[[C. trachomatis]] and [[N. gonorrhoeae]] testing if risk of infection (consider with post-coital bleeding)
	*Consider follow up for non-emergent [[pelvic ultrasound]]		*Consider follow up for non-emergent [[pelvic ultrasound]]
	**No indication for emergent ultrasound in ED		**No indication for emergent ultrasound in ED

2025-02-26T22:27:50Z

Evaluation

← Older revision		Revision as of 22:27, 26 February 2025
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	{{PALM-COEIN Classification}}		{{PALM-COEIN Classification}}

	*Age 12-18: most commonly immature hypothalamic-pituitary-ovarian axis, also consider bleeding dyscrasia
	*Age 19-39: most commonly structural lesion (fibroid, polyp) or PCOS
	*Age 40+: most commonly endometrial atrophy, also consider malignancy especially in post-menopausal<ref>https://www.ebmedicine.net/topics/gynecologic-obstetric/bleeding</ref>

	===Diagnosis===		===Diagnosis===
			*Common etiologies by age:
			**Age 12-18: most commonly immature hypothalamic-pituitary-ovarian axis, also consider bleeding dyscrasia
			**Age 19-39: most commonly structural lesion (fibroid, polyp) or PCOS
			**Age 40+: most commonly endometrial atrophy, also consider malignancy especially in post-menopausal<ref>https://www.ebmedicine.net/topics/gynecologic-obstetric/bleeding</ref>
	*Hemodynamically stable patient in ED must rule-out:		*Hemodynamically stable patient in ED must rule-out:
	**[[Pregnancy]]		**[[Pregnancy]]

2025-02-26T22:26:38Z

Evaluation

← Older revision		Revision as of 22:26, 26 February 2025
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	==Evaluation==		==Evaluation==

	~~{{PALM-COEIN Classification}}~~


	*Age 12-18: most commonly immature hypothalamic-pituitary-ovarian axis, also consider bleeding dyscrasia
	*Age 19-39: most commonly structural lesion (fibroid, polyp) or PCOS
	*Age 40+: most commonly endometrial atrophy, also consider malignancy especially in post-menopausal<ref>https://www.ebmedicine.net/topics/gynecologic-obstetric/bleeding</ref>

	===Work-Up===		===Work-Up===
	*Urine pregnancy		*Urine pregnancy
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	**No indication for emergent ultrasound in ED		**No indication for emergent ultrasound in ED

	===~~Evaluation~~===		{{PALM-COEIN Classification}}

			*Age 12-18: most commonly immature hypothalamic-pituitary-ovarian axis, also consider bleeding dyscrasia
			*Age 19-39: most commonly structural lesion (fibroid, polyp) or PCOS
			*Age 40+: most commonly endometrial atrophy, also consider malignancy especially in post-menopausal<ref>https://www.ebmedicine.net/topics/gynecologic-obstetric/bleeding</ref>

			===Diagnosis===
	*Hemodynamically stable patient in ED must rule-out:		*Hemodynamically stable patient in ED must rule-out:
	**[[Pregnancy]]		**[[Pregnancy]]

2025-02-05T21:34:19Z

← Older revision		Revision as of 21:34, 5 February 2025
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	[[This page is for women of reproductive age. For younger patients, see [[prepubertal vaginal bleeding]].		''This page is for women of reproductive age. For younger patients, see [[prepubertal vaginal bleeding]].''
	==Background==		==Background==
	[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]		[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]

2025-02-05T21:33:48Z

← Older revision		Revision as of 21:33, 5 February 2025
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	[[This page is for women of reproductive age. For younger patients, see [[prepubertal vaginal bleeding.]]		[[This page is for women of reproductive age. For younger patients, see [[prepubertal vaginal bleeding]].
	==Background==		==Background==
	[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]		[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]

2025-02-05T21:05:45Z

← Older revision		Revision as of 21:05, 5 February 2025
Line 1:		Line 1:
			[[This page is for women of reproductive age. For younger patients, see [[prepubertal vaginal bleeding.]]
	==Background==		==Background==
	[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]		[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]

2024-05-01T16:49:20Z

Background

← Older revision		Revision as of 16:49, 1 May 2024
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	==Background==		==Background==
			[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]
			[[File:Uterine arterial vasculature.svg\|thumb\|Diagram of uterine blood supply.]]
	*This page is for the generalized approach to undifferentiated vaginal bleeding in non-pregnant women		*This page is for the generalized approach to undifferentiated vaginal bleeding in non-pregnant women
	*Normal menstruation:		*Normal menstruation:

2021-09-30T15:18:43Z

Evaluation

← Older revision		Revision as of 15:18, 30 September 2021
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	==Evaluation==		==Evaluation==

			{{PALM-COEIN Classification}}


			*Age 12-18: most commonly immature hypothalamic-pituitary-ovarian axis, also consider bleeding dyscrasia
			*Age 19-39: most commonly structural lesion (fibroid, polyp) or PCOS
			*Age 40+: most commonly endometrial atrophy, also consider malignancy especially in post-menopausal<ref>https://www.ebmedicine.net/topics/gynecologic-obstetric/bleeding</ref>

	===Work-Up===		===Work-Up===
	*Urine pregnancy		*Urine pregnancy
	*Complete blood count		*Complete blood count
	*Coags (~~only~~ if history of or suspect ~~coaulopathy~~)		*Coags (if history of or suspect coagulopathy)
	*TSH, prolactin (~~only~~ if suspect endocrine disorder)		*TSH, prolactin (if suspect endocrine disorder)
	*C. trachomatis and N. gonorrhoeae testing if risk of infection		*C. trachomatis and N. gonorrhoeae testing if risk of infection (consider with post-coital bleeding)
	*Consider follow up for non-emergent [[pelvic ultrasound]]		*Consider follow up for non-emergent [[pelvic ultrasound]]
	**No indication for emergent ultrasound in ED		**No indication for emergent ultrasound in ED
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	**Retained [[vaginal foreign body]]		**Retained [[vaginal foreign body]]
	**If work up negative, can refer for further outpatient work up		**If work up negative, can refer for further outpatient work up

	~~{{PALM-COEIN Classification}}~~

	==Management==		==Management==