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Abnormal uterine bleeding is an overarching term that is defined as bleeding from the uterine corpus that is irregular in volume, frequency, or duration in absence of pregnancy (Table 96–1).1 Vaginal bleeding is a common complaint in the ED, and differential diagnoses include pregnancy, structural abnormalities (e.g., polyps, fibroids), endometritis, coagulopathies, trauma, and various other causes. The prevalence of abnormal bleeding is estimated at 9% to 14% in the general population. Although vaginal bleeding may present as an acute or chronic problem, this chapter will focus on the ED evaluation and management of abnormal uterine bleeding.

Table 96–1

FIGO Terminology for Bleeding*


In North America, average age of menarche is 12.5 years of age, approximately 2 years after the development of thelarche (breast budding). Early cycles are often anovulatory and irregular due to the immaturity of the hypothalamic-pituitary axis. Regular ovulatory cycles develop on average 2 years after the start of menarche.

The normal menstrual cycle is 28 days and is divided into four phases: menses, follicular, ovulation, and luteal or secretory. Figure 96–1 depicts hormonal and endometrial changes associated with a normal menstrual cycle.

FIGURE 96–1.

The hormonal, ovarian, endometrial, and basal body temperature changes and relationships throughout the normal menstrual cycle. E2 = prostaglandin E2; FSH = follicle-stimulating hormone; LH = luteinizing hormone; P = progesterone. [Reproduced with permission from Patel DR, Greydanus DE, Baker RJ: Pediatric Practice Sports Medicine. © 2009, McGraw-Hill, New York, NY.]

In response to the rising estrogen levels, the pituitary gland secretes follicle-stimulating hormone and luteinizing hormone, which stimulates the release of the mature oocyte. The residual follicular capsule forms the corpus luteum. During the luteal phase, the corpus ...

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