[##]-year-old female with history and
exam consistent with likely dysfunctional uterine bleeding.
Initial consideration in this patient
included pregnancy, ectopic pregnancy, non-structural (coagulopathy, ovulatory
dysfunction, endometrial, iatrogenic) and structural causes (polyp,
adenomyosis, leiomyoma, malignancy or hyperplasia), urinary tract infection
(UTI), vaginitis, [differentia diagnosis], and vaginal, perineal, and cervical
trauma among others.
Patient presented with [menorrhagia
(>7 days (prolonged) or >80 mL/day (excessive) uterine bleeding at regular
intervals/metrorrhagia (irregular vaginal bleeding outside the normal cycle)/menometrorrhagia
(excessive irregular vaginal bleeding)] suggestive of likely dysfunctional
uterine bleeding. Pelvic exam performed
with [dark red blood in vaginal vault without evidence of brisk or active
bleeding]. A pregnancy test was obtained
and noted to be negative making pregnancy-related complications unlikely.
Given evidence of [mild/moderate/severe]
uterine bleeding on evaluation in the ED, we [discussed/initiated] treatment
with [iron supplementation and Ibuprofen/initiation of oral contraceptive/Medroxyprogesterone
intramuscular injection/tranexamic acid (TXA) and consulted Gynecology].
Patient noted to have no evidence of significant
anemia on [exam/hemoglobin and hematocrit].
Patient noted to have no evidence of coagulopathy on [history/exam/labs]. Patient noted to have no evidence of
endocrine disorder on history or exam. No
evidence of UTI on urinalysis in the ED.
Vaginitis considered unlikely based on history and exam.
Prior to discharge, we discussed return precautions, specifically
for evidence of worsening or persistent bleeding, treatment [with specify
interventions], and follow up with [primary care doctor/Gynecology] within [2-3
days/1 week] for further evaluation, and the patient demonstrated understanding
and agreement with this plan.
https://wikem.org/wiki/Vaginal_Bleeding_(Non-Pregnant)
http://www.emdocs.net/non-pregnant-vaginal-bleeding/
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