Tiny Tips: Approach to Abnormal Uterine Bleeding

In Medical Concepts, Tiny Tips by Zoe PolskyLeave a Comment

Whether the patient is an expecting mother, a post-menopausal woman, or a young adolescent, abnormal uterine bleeding is distressing for the patient, and often overwhelming for learners. Consider the CAUSES OF bLOOD to better tailor your investigations and management.

Urogenital infections (PID, endometritis, salpingitis)
Severe menorrhagia
Ectopic pregnancy
Spontaneous abortion

Ovarian cyst rupture
Fibroid (Leiomyoma)

Location of placenta- placenta previa
Ovarian torsion
Onset after delivery – Post-Partum Hemorrhage
Drugs – anticoagulants, antipsychotics, corticosteroids, hormone replacement

This post was copyedited by Dat Nguyen-Dinh (@dat_nd).

Reviewing with the Staff

The above mnemonic provides a reasonable, but not comprehensive, differential for abnormal uterine bleeding. This approach will be helpful to junior learners who want to ensure that they consider various causes of uterine bleeding. Advanced learners should have expanded differentials that are based on categorical clusters such the patient’s reproductive status (e.g. premenarchal, fertile, pregnant, postmenopausal) and/or categories of disease (e.g. reproductive tract disease, iatrogenic causes, systemic causes). Always remember that fertile females presenting to the emergency department with uterine bleeding should be considered pregnant until proven otherwise.

Dr Brent Thoma
Assistant Professor, University of Saskatchewan Department of Emergency Medicine

Zoe Polsky

Zoe Polsky is a medical student at the University of Calgary and an EM enthusiast. She is a facilitator of peer-led simulation, and has a strong interest in addiction medicine and harm reduction.

Latest posts by Zoe Polsky (see all)