- Very excessive vaginal bleeding is a cause of emergency presentation to the gynaecology unit.
- The presentation may be due to the bleeding itself or to the secondary symptoms of either acute or chronic anaemia.
- Excessive bleeding is a subjective diagnosis by the woman and methods to quantify the amount of bleeding are of limited use.
- This is also covered in the Abnormal uterine bleeding tutorial.
Causes of acute excessive menstrual bleeding
|Uterine pathology||Fibroids, adenomyosis, endometrial pathology (e.g. polyp)|
|Anovulatory bleeds ||polycystic ovary, perimenopause, perimenarche|
|Systemic disease||Thyroid disorders, hepatic diseases, renal diseases, adrenal hyperplasia and Cushing's disease|
|Coagulopathy||Von Willebrands disease, thrombocytopenia|
|Iatrogenic||Intrauterine contraceptive device in situ|
|Medication||Anticoagulants, antipsychotics, corticosteroids, progestin-only pill, SSRI’s, tamoxifen, thyroid hormone replacement, herbal and other supplements such as ginseng, ginkgo and soy|
|Heavy menstrual bleeding||Diagnosis of exclusion|