Abnormal vaginal bleeding during reproductive years

N92.0-2

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

Increased vaginal blood flow in either volume, duration, and/or frequency, including menorrhagia or dysfunctional uterine bleeding.

GENERAL MEASURES

• Assess current contraceptives used.
• Exclude pregnancy complication or organic disease e.g. cervical cancer, fibroids.

MEDICINE TREATMENT

• Combined oral contraceptive pill (ethinylestradiol/levonorgestrel) for 3–6 months.
• Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for 2–3 days.
  • Ibuprofen may reduce blood loss in menorrhagia associated with intrauterine contraceptive device (IUCD) or chronic salpingitis (See Sexually transmitted infections ).

If blood loss has been severe or there are signs of anaemia:

• Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly with meals.

OR

• Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly.
  • Continue for 3 months after the Hb normalises - to replenish body iron stores.
  • Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).

LoEIII [49]

REFERRAL

• No improvement.
• Girls <12 years of age with vaginal bleeding before the development of their secondary sexual characteristics.
• For investigation of other causes such as:
  • sexual abuse
  • foreign bodies
  • tumours of the genital tract
• Severe anaemia.