An examination under anesthesia (EUA) may be necessary to exclude a vaginal foreign body or tumor, although instruments designed for office hysteroscopy can sometimes be used in children with topical anesthesia for office vaginoscopy, precluding the need for sedation or general anesthesia and operating room time. Premenopausal
Background
In premenopausal women, bleeding can be from the uterus, from vulvar or vaginal lesions, or from the cervix. A gynecologic examination can be performed to determine the source of bleeding. Bleeding may also occur as a result of a pregnancy complication, such as a spontaneous abortion (miscarriage), ectopic pregnancy, or abnormal growth of the placenta, even if the woman is not aware of the pregnancy. This possibility must be kept in mind with regard to diagnosis and management. Generally, the causes of abnormal uterine bleeding in premenopausal women who are not pregnant include fibroids, polyps, hormonal disorders such as polycystic ovary syndrome (PCOS), blood clotting disorders, and cancer. Infections such as cervicitis or pelvic inflammatory disease (PID) can also result in vaginal bleeding. Postcoital bleeding is bleeding that occurs after sexual intercourse. Lastly, a normal and common side effect of birth control includes vaginal spotting or bleeding. Clinical guidelines (FIGO classification)
A more specific clinical guideline, called the PALM-COEIN system, has been developed by FIGO (International Federation of Gynecology and Obstetrics) to classify the causes of abnormal uterine bleeding. This acronym stands for Polyp, Adenomyosis, Leiomyoma, Malignancy and Hyperplasia, Coagulopathy, Ovulatory Disorders, Endometrial Disorders, Iatrogenic Causes, and Not Classified.
Women with blood clotting disorders may also need to see a hematologist.Surgical treatments may also be considered if the bleeding is severe or if there are reasons patients cannot take the hormonal medications listed above. These options include dilation & curettage, endometrial ablation, and hysterectomy (removal of the uterus). Hysterectomy will result in infertility, so surgical decisions will include womens preferences regarding future fertility when possible. See also
Istihadha
Abnormal uterine bleeding
Implantation bleeding

References


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