1. Abnormal Bleeding PV Common complaint in the out patient dept

2. Normal menstrual loss- 80 ml Menorrhagia- normal cycle- increased bleeding, prolonged or excessive Polymennorrhea- short cycles, normal bleeding Poly menorrhagia- short cycles, increased bleeding Metrorrhagia- loss of cyclicity- irregular bleeding Metropathia haemorrhagica- amenorrhoea followed by prolonged bleeding

3. Case scenario 1 15 year old with bleeding pv for 1 month History? Examn? Investigations?

4. History Menarche Menstrual history LMP PMP Amount of blood flow- clots? Pain Bleeding gums/elsewhere Fever Weight gain/loss Headache/ visual disturbances

5. Physical exam Built Anaemia Hirsuitism Goitre Galactorrhoea Mass in the abdomen P/R

6. Investigations Hb BT CT Platelet count Peripheral smear TFT ESR Urine sugar

7. Treatment Haematinics Underlying cause if any Progesterone to control bleeding- 20-30 mg for 3 days Cyclical hormone treatment

8. Case 2 28 year old with increased bleeding pv for 15 days History Physical exam Ix

9. History Menstrual history Obstetric history- include MTP Contraceptive use Dysmenorrhoea Discharge pv Fever/ bleeding tendency/ cough/ hypothyroidism Post coital bleeding/ irregular spotting

10. Physical exam Anaemia Goitre P/v- Visualise cervix- look for erosion, cervicitis, Ca, Polyps, vaginitis Look at size of uterus, uniformly enlarged?, mass in fornices, tenderness

11. Investigations Hb, Tc Dc ESR Urine sugar ? Urine beta Hcg USS if needed Pap smear

12. Treatment If suspicion of pregnancy, USS/ D&C Attend to cervical lesions if any Treat polyps with polypectomy Proper use of contraceptives If no organic lesion EACA, Tranexamic acid Mefenamic acid Menstrual calender haematinics