Abnormal Vaginal Bleeding

Key Points

• Anovulation is common in adolescents.

• Bleeding disorders typically present as menorrhagia in adolescence.

• Anovulation is the most common cause of abnormal vaginal bleeding in reproductive-age women.

• The four most common causes of secondary amenorrhea are pregnancy, hyperprolactinemia, thyroid disorders, and iatrogenic.

• Evaluation of abnormal bleeding in women over age 35 should include an endometrial biopsy.

• Anovulatory women are at risk for endometrial hyperplasia or carcinoma from unopposed estrogen and should have regular progesterone-induced withdrawal bleeds.

• Any bleeding after menopause in a woman who is not taking hormone therapy is abnormal.

• Evaluation with an endometrial biopsy or a pelvic ultrasound can exclude endometrial cancer.

Normal menstrual bleeding is defined as regular vaginal bleeding that occurs at intervals from 21 to 35 days. A normal menstrual cycle begins with the follicular phase before ovulation and then the luteal phase after ovulation. Abnormal vaginal bleeding is a common complaint in primary care. The prevalence of some type of abnormal bleeding is 10% to 30% among women of reproductive age. The estimated annual direct and indirect costs of abnormal bleeding are $1 and $12 billion, respectively (Liu et al., 2007). Abnormal bleeding is also a common reason for women to be referred to gynecologists and is an indication for up to 25% of all gynecologic surgery (Goodman, 2000). A life cycle approach to abnormal vaginal bleeding is helpful in determining etiology and treatment options.

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Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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