Physical findings
Pallor not associated with tachycardia or signs of hypovolemia suggests chronic excessive blood loss, such as that occurring with anovulatory bleeding, adenomyosis, uterine myomas, or blood dyscrasia.
Signs of impending shock indicate that the blood loss is likely related to pregnancy (including ectopic), trauma, sepsis, or neoplasia.
Pelvic masses may represent pregnancy, uterine or ovarian neoplasia, or a pelvic abscess or hematoma.
Fever, leukocytosis, and pelvic tenderness suggests PID.
Fine, thinning hair, and hypoactive reflexes suggest hypothyroidism.
Ecchymoses or multiple bruises may indicate trauma, coagulation defects, medication use, or dietary extremes
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Laboratory tests
CBC and platelet count and a urine or serum pregnancy test should be completed.
Screening for sexually transmitted diseases, thyroid function, and coagulation disorders (partial thromboplastin time, INR, and bleeding time) is necessary.
Endometrial sampling is rarely necessary for those under age 20.
Treatment of infrequent bleeding
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Therapy should be directed at the underlying cause when possible.
If the CBC and other initial laboratory tests are normal and the history and physical examination are normal, reassurance is usually all that is necessary.
Ferrous gluconate, 325 mg bid-tid, should be prescribed.
Treatment of frequent or heavy bleeding
Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) improve platelet aggregation and increase uterine vasoconstriction.
NSAIDs are the first choice in the treatment of menorrhagia because they are well tolerated and they do not have the hormonal effects of oral contraceptives. Additionally, women with menorrhagia frequently also have dysmenorrhea, and NSAIDs are effective for this problem.
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