The assessment and referral of women with abnormal vaginal bleeding.
|
|
|
|
|
|
Anticipated outcomes
|
Women presenting with abnormal vaginal bleeding will receive consistent assessment and appropriate medical referral by the women's health nurse practitioner.
|
Responsibility
|
The women's health nurse practitioner is responsible for:
|
- assessment and referral of women with abnormal vaginal bleeding as required
|
- establishment of a process for ensuring follow up of women who fail to attend the required medical consultation
|
|
Eligible women are non pregnant women who present with abnormal vaginal bleeding.
|
Ineligible women are those presenting with conditions that require urgent medical attention, e.g. acute pain or excessively frequent or prolonged vaginal bleeding.
|
 |
|
|
| | | Regular heavy menstrual bleeding
|
| Excessive amount (>80ml /cycle) or prolonged duration (>7 days/cycle); also called "menorrhagia" or "hypermenorrhoea"
|
| Occurs at regular intervals
|
| | Bleeding or spotting between normal periods
|
| Between periods, usually light flow
|
| Irregular menstrual bleeding
|
| Bleeds less than 21 days or more than 35 days for three cycles or more
|
| | Post coital bleeding
| Post menopausal bleeding
|
| Bleeding following sexual intercourse
| Bleeding 2 years after menopause if age less than 50 or bleeding after 1 year if age greater than 50.
|
| |
|
|
|
History
|
The women's health nurse practitioner should take a careful history, documenting:
|
General
|
|
- current medications including hormonal
|
|
|
- drug use (prescription, over the counter, illicit use)
|
- height, weight, body mass index
|
|
Gynaecological
|
- previous episodes of abnormal vaginal bleeding and previous investigations
|
|
|
|
- known gynaecological conditions
|
|
Obstetric
|
|
- infertility / subfertility
|
|
Menstrual
|
- last normal menstrual period (LNMP), presence of pregnancy symptoms
|
- age at menarche and menopause, any post-menopausal bleeding (PMB)
|
- intermenstrual bleeding (IMB)
|
- cycle length, duration, estimated amount of flow, dates and patterns of last three normal menstrual periods
|
|
|
- colour / character of flow and any related signs and symptoms, e.g. pain, odour, discharge
|
|
Contraceptive
|
- contraceptive use, type, length of time used, any side effects
|
|
Sexual
|
- risk assessment for sexually transmissible infections and blood borne viruses
|
- post coital bleeding (PCB)
|
|
Family
|
- history of breast, endometrial or bowel cancer
|
- history of abnormal bleeding including known blood dyscrasias, coagulation defects, haemorrhage or bruising
|
|
|
|
Download information
|
|
|
Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
|
Please remember to read our disclaimer.
|
