1. Abnormal Bleeding
CAPT Mike Hughey, MC, USNR

2. Causes of Abnormal Bleeding
1. Pregnancy
2. Malignancy
3. Mechanical Problems
4. Hormonal Problems .

3. Rule out Pregnancy
Patients of childbearing age with unexplained abnormal bleeding should have a pregnancy test

4. Rule out Malignancy Cervical cancer (Pap) Vaginal cancer (Exam)
Ovarian cancer (Exam)
Uterine cancer (Endometrial biopsy, but under age 40, cancer very rare)
Invasive Cancer of the Cervix

5. Mechanical Problems
Polyps
Fibroids

6. Hormonal Problems
Anovulation
Ovulatory bleeding
Delayed menses

7. Clinical Management: Evaluation
1. Pregnancy Test
2. CBC (anemia)
3. Recent negative Pap smear
4. Pelvic exam

8. Clinical Management: Treatment
BCPs
Bedrest

9. Clinical Management: MEDEVAC
If BCPs/Bedrest fail to resolve the bleeding and it is heavy, MEDEVAC is the next step.
Surgery (D&C, hysteroscopy, etc.) will be needed.
This is best undertaken in other than operational settings.