Clinical evaluation of abnormal vaginal bleeding

A. A menstrual and reproductive history should include last menstrual period, regularity, duration, frequency; the number of pads used per day, and intermenstrual bleeding.

B. Stress, exercise, weight changes and systemic diseases, particularly thyroid, renal or hepatic diseases or coagulopathies, should be sought. The method of birth control should be determined.

C. Pregnancy complications, such as spontaneous abortion, ectopic pregnancy, placenta previa and abruptio placentae, can cause heavy bleeding. Pregnancy should always be considered as a possible cause of abnormal vaginal bleeding.

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