Intermenstrual bleeding

Differential diagnosis

  • Cervical, vaginal Ca – smear, weight loss, PCB
  • Ectopic – LMP
  • STI – fevers, PV discharge, sexual history
  • Ectropion – PCB
  • Polyp
  • Ovulation spotting
  • Trauma
  • UTI – dysuria, frequency
  • PR bleed – bowel habit
  • Medications – HRT, tamoxifen, oral contraception

 

Data gathering

  • Red flags – PCB, pregnant, fevers, weight loss, missed smears
  • Others – as above
  • Examine
    • BP, pulse, temperature
    • speculum/pelvic
    • urine dip, pregnancy test

 

Clinical management

  • Investigations
    • Swabs
    • Pregnancy test
    • Cervical smear (if due)
    • USS pelvis
  • Treatment
    • Treat underlying cause
  • Follow-up / Safety-net