Dr. Reenie Devadasan*

Abnormal vaginal bleeding could be from any part of the genital tract and

it can occur at any age. Whenever a person presents with abnormal vaginal bleeding, it is essential to get a proper history about the type of bleeding, cycles, amount of blood loss etc. The age of a patient is also important as the causes of abnormal

vaginal bleeding varies in different age group. We must proceed to investigate a patient systematically avoiding unnecessary investigations. From the type of bleeding we could form an idea about the probable cause of bleeding.

Menorrhagia - Increased flow with normal cycles _ fibroids, polypi,PID.

Polymenorrhoea -Shortened Cycles _ HPO axis dysfunction, PID.

Metrorrhoea -Intermenstrual bleeding _ Uterine polypi, erosion cervix, cancer cervix, cancer body.

Continuous bleeding -Abortion, ectopic, cancer cervix, polypi, metropathia, haemorrhagica.

Post menopausal bleeding -Bleeding from genital tract in a woman of post menopausal age whohas not had a period during the past six months _ 50-60% due to malignancy.

While investigating and managing a patient who presents with abnormal vaginal bleeding the following protocol may be followed:

• Only as the last resort.

• Caution : Think of bleeding disorders and investigate if necessary.

• Avoid unnecessary investigations (T4, TSH, FSH, LH) unless strongly suspect.