Causes of Vaginal Bleeding

  •  Causes of Vaginal Bleeding
    Differential diagnosis Laboratory data Signs and symptoms Treatment
    Menses CBC count, urine hCG Cyclic bleeding every 21–35 d Iron therapy if indicated
    Dysfunctional uterine bleeding CBC count, urine hCG, endometrial biopsy if >35 yr, duration >6 mo Noncyclic bleeding; may have associated dysmenorrhea, fatigue, or dizziness Hormonal therapy if patient is hemodynamically stable; if hemodynamically unstable, transfuse as needed, IV estrogen or high-dose oral contraceptive pills
    Infection: gonorrhea/chlamydia cervicitis Cervical culture, wet prep Purulent vaginal discharge, possible spotting Ceftriaxone, 125 mg IM × 1; azithromycin, 1 g PO × 1
    Trichomonas vaginitis Wet prep Yellow-green frothy vaginal discharge, possible spotting Metronidazole, 500 mg PO BID × 7 days or 2 g PO × 1 (if pregnant, defer treatment to second trimester)
    Sexual trauma Rape kit Vaginal bleeding and/or discharge Emergency contraception, prophylactic treatment for sexually transmitted diseases; if laceration, pack vagina, possible surgical repair
    Malignancy Endometrial biopsy, Pap smear, cervical biopsy Postmenopausal bleeding, postcoital bleeding, intermenstrual bleeding Refer to gynecologic oncologist
    BID, twice daily; CBC, complete blood cell; hCG, human chorionic gonadotropin; IM, intramuscular; IV, intravenous; PO, oral.