Heres a good general approach: A good rule of thumb is that bleeding that is lighter than the patients usual menstrual period is reassuring Bleeding heavier than menses should make you pause, consider US imaging, and definitely consider a pelvic exam (see below) And true heavy bleeding is when the patient soaks through a maxi-pad per hour for more than 2 hours this is concerning bleeding requiring a pelvic exam, imaging, intervention, and usually OB/Gyne consultation Other vaginal symptoms (including abnormal discharge or symptoms of infection) Pain or cramping (including severity and location) Symptoms of hemodynamic compromise (like dizziness, orthostasis, and syncope) Past obstetric, medical, and surgical histories, including history of previous pregnancy loss, ectopic pregnancy, and use of assisted reproductive technology And the key points on your physical exam : Vital signs Abdominal exam Red flags = unilateral tenderness, palpable adnexal mass, peritonitis Pelvic exam do we need to do it
These can help bolster your case for medication by showing youve tried other methods
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Fragrance-heavy formulations skin thats stressed is more reactive
And where demand spikes, so do fakes
Sunde M, Serpell LC, Bartlam M, Fraser PE, Pepys MB, Blake CCF
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