Irregular Bleeding and Intermenstrual Bleeding

 

Refer to Menstrual Disorders Clinic with pelvic USS attached

 

Definition

Vaginal bleeding (other than post coital) at any time in the cycle other than during normal menstruation

 

Urgency

• Persistent  bleeding in >45 years or risk factors  eg obesity, PCOS, unopposed estrogen, tamoxifen) – Refer urgently and request USS
• Suspicious cervix on examination - Refer  2ww
• Otherwise routine referral

 

Information to include in referral letter 

• Problem and length of symptoms
• Current contraception
• Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the consultation 
• Speculum findings (eg normal / ectropion / cervicitis / cervical polyp) 

 

Investigations prior to referral

• Chlamydia screening
• High Vaginal Swab
• Pelvic USS
• NB DON’T perform a cervical smear if outside the screening programme

 

Date:          December 2020    Review Date:      December 2021

Author:Dr S Burns

Contributors:Lisa Verity Gynaecology consultant RCHT 

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