Operational Medicine Medical Education and Training

Abnormal Bleeding

Normal menstrual bleeding:

  • Occurs approximately once a month (every 26 to 35 days).
  • Lasts a limited period of time (3 to 7 days).
  • May be heavy for part of the period, but usually does not involve passage of clots.
  • Often is preceded by menstrual cramps, bloating and breast tenderness, although not all women experience these premenstrual symptoms.

Abnormal Bleeding

Abnormal bleeding (DUB or dysfunctional uterine bleeding) includes:

  • Too frequent periods (more often than every 26 days).
  • Heavy periods (with passage of large, egg-sized clots).
  • Any bleeding at the wrong time, including spotting or pink-tinged vaginal discharge
  • Any bleeding lasting longer than 7 days.
  • Extremely light periods or no periods at all

Abnormal Bleeding

PowerPoint
10 Slides
0.9 MB (.ppt) file

Free Download Now

 

MensesNormal250.jpg (16262 bytes)

Overview

Any woman complaining of abnormal vaginal bleeding should of course be examined. Occasionally, you will find a laceration of the vagina, a bleeding lesion, or bleeding from the surface of the cervix due to cervicitis. Much more commonly, you will find bleeding from the uterus coming out of the cervical os.

Excluding pregnancy, there are really only three reasons for abnormal uterine bleeding:

  • Mechanical Problems
  • Hormonal Problems
  • Malignancy

The limited number of possibilities makes your caring for these patients very simple. First, before examining the patient, obtain a pregnancy test. If it is positive, then don't do anything more until you've read about the different possible causes.

Next, obtain a blood count and assess the rate of blood loss to determine how much margin of safety you have. Someone with a good blood count (hematocrit) and minimal rate of blood loss (less than a heavy period), can tolerate this rate of loss for many days to weeks before the bleeding itself becomes a threat.

Pregnancy Problems

A variety of pregnancy problems can cause vaginal bleeding. These include:

  • Abortion (threatened, incomplete, complete, missed, or inevitable)

  • Ectopic Pregnancy

  • Placental Abruption

  • Placenta Previa

If the bleeding patient has a positive pregnancy test, a careful search should be made for each of these problems. However, if the pregnancy test is negative, pregnancy-related bleeding problems are effectively ruled out.

Mechanical Problems

Such problems as uterine fibroids or polyps are examples of mechanical problems inside the uterus.

Since mechanical problems have mechanical solutions, these patients will need surgery of some sort (Polypectomy, D&C, Hysteroscopy, Hysterectomy, Myomectomy, etc.) to resolve their problem.

In the meantime, have them lie still and the bleeding will improve or temporarily go away. Giving hormones (like birth control pills) in an effort to stop the bleeding will not help this condition, but neither will it be harmful.

Polyps visible protruding from the cervix are usually coming from the cervix and can be easily twisted off. However, they will need microscopic evaluation, so removal in many operational settings may not be desired. Instead, they can await return to a non-deployed setting.

Another form of mechanical problem is an IUD causing abnormal bleeding. These should always be removed.

From:

Operational Obstetrics & Gynecology
2nd Edition
NAVMEDPUB 6300-2C

Bureau of Medicine and Surgery
Department of the Navy

Continue to the PowerPoint Lecture...

 

 

 

 

 

Home    Textbooks and Manuals    Videos    Lectures    Distance Learning    Training    Operational Safety   Supplies and Equipment    Search    About Us

www.operationalmedicine.org

This website is dedicated to the development and dissemination of medical information that may be useful to those who practice Operational Medicine. This website is privately-held and not connected to any governmental agency. The views expressed here are those of the authors, and unless otherwise noted, do not necessarily reflect the views of the Brookside Associates, Ltd., any governmental or private organizations. All writings, discussions, and publications on this website are unclassified.

2006, 2007, 2008, Medical Education Division, Brookside Associates, Ltd. All rights reserved

Other Brookside Products

Contact Us

Advertise on this Site