Author Topic: Inter menstrual Bleeding  (Read 5324 times)

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Offline Ahmed_07

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Inter menstrual Bleeding
« on: April 28, 2012, 04:46:17 PM »
Description: Bleeding between otherwise normal menstrual
cycles is called intermenstrual bleeding.
Prevalence: Ten percent to 15% of all gynecologic visits
involve menstrual disturbances.
Predominant Age: Reproductive, greatest in adolescents
and patients who are climacteric.
Genetics: No genetic pattern
Causes: Uterine (pregnancy, endometrial polyps, endometrial
hyperplasia, endometrial carcinoma, leiomyomata),
cervical (polyps, cervicitis, cervical erosion,
cervical dysplasia/neoplasia), vaginal (trauma, infection,
atrophy), perineal (vulvar lesions, hemorrhoids).
Risk Factors: None known. (The purported relationship
to surgical sterilization has been disproved.)
Signs and Symptoms
• Intermenstrual bleeding (painless)
• Bleeding after intercourse (common)

Diff erential Diagnosis
• Pregnancy
• Climacteric changes
• Anovulation
• Endometrial polyps
• Uterine leiomyomata
• Cervical polyps, lesions, or cervicitis
• Endometrial cancer
• Endometriosis
• Nonuterine sources of bleeding (e.g., vaginal, vulvar, or
• Coagulopathy (congenital or acquired)
• Iatrogenic (intrauterine device use, medications)
Associated Conditions: Endometrial hyperplasia, endometrial
cancer, endometrial polyps, endocervical polyps
or carcinoma, uterine leiomyomata.
Workup and Evaluation
Laboratory: Testing should be chosen on the basis of
diagnoses being considered.
Imaging: No imaging indicated.
Special Tests: A menstrual calendar helps to document
the timing and character of the patient’s bleeding. Endometrial
biopsy, curettage, or hysteroscopy may be
Diagnostic Procedures: History and physical examination
often point to possible causes for further
Drug(s) of Choice
Based on cause. Hormonal agents that produce endometrial
thinning (such as combination contraceptives or
long-acting progestins) can be useful in selected patients
when conception is not desired.
Patient Monitoring: Normal health maintenance.
Prevention/Avoidance: None.
Possible Complications: Anemia.
Expected Outcome: Return to normal menstrual pattern
with correction of underlying pathologic condition or
periodic progestin therapy.

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