Hello, med students. My name is Zach Olson and thank you for downloading this week's

episode of the EM Clerkship Podcast. This week we are talking about vaginal bleeding again. And the

most important thing to remember about these cases is the pregnancy test.

The point of care pregnancy test in females of reproductive age is one of the big three stat tests in all of emergency medicine.

The other two being EKGs and finger stick blood glucose.

You always need a pregnancy test.

Now let's say this time that a woman comes in with vaginal bleeding, and it turns out she is not pregnant.

If the patient is unstable, they need blood, they need OB, and resuscitation, that's easy.

But what if she's stable? These ones are a little bit trickier.

How do you manage those? Well, the first thing you need to understand is the cause of the bleeding.

And there are three big categories that you need to know. The first one is structural and the main can't miss diagnosis

here is malignancy. Postmenopausal vaginal bleeding needs to be evaluated for malignancy.

There are other structural causes too like fibroids, polyps, adenomyosis, all incredibly common. But again, postmenopausal vaginal bleeding,

the life threat is malignancy. The second category is coagulopathy. This is a huge category.

This is about 20% of your patients actually who come in with non-pregnant vaginal bleeding.

They have a coagulopathy.

And then the last category here is hormonal issues.

This is called dysfunctional uterine bleeding and ovulatory bleeding.

Thyroid kind of can affect this too, but hormonal issues is your third big category.

So those are the three.

Structural, especially malignancy

and postmenopausal females, coagulopathy, and hormonal issues. Now, let's go through our approach.

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