ABNORMAL VAGINAL BLEEDING

A   31-year-old woman   complains   of  six months  of  menometrorrhagia.   The

patient states  that    she started having  menstruation    at  age 13  and that    she has

had regular menses  until   the past    six months. The pelvic  examination,

including   a   Pap smear,  is  normal. She has no  other   significant personal    or

family  history.

Pregnancy

In a patient who has abnormal bleeding during the reproductive age group,
pregnancy or a complication must first be considered. Complications of early
pregnancy that are associated with bleeding include incomplete abortion,
threatened abortion, ectopic pregnancy, and hydatidiform mole.

Diagnosis. Urine or serum β-hCG test is required to confirm pregnancy. If
pregnancy is identified vaginal ultrasound will help sort out which pregnancy
complication is operative.

Management. Varies with the individual diagnosis.

Anatomic Lesion

If the pregnancy test is negative, then an anatomic cause of vaginal bleeding
should be considered. The classic history is that of unpredictable bleeding
(without cramping) occurring between normal, predictable menstrual periods
(with cramping).