Ask about associated pain, discharge, bladder symptoms, nausea and vomiting, fever, infertility, and other history points. The basic general complete gynecologic history and physical examination will be extremely helpful. Many associated findings in the history and physical examination must be evaluated in order to determine the etiology of abnormal bleeding. The history should determine the following information: Hypomenorrhea is the term for abnormally low bleeding, substantially less than 30 ml per menstrual cycle, and hypermenorrhea refers to excessive bleeding, over 90 ml, in a cycle of normal duration. Intermenstrual bleeding occurs between menses, discontinuous with the cycle. Metrorrhagia is an increased duration of menstrual flow beyond 7 days and continuous with the cycle. Amenorrhea (absence of menses) refers to failure to menstruate for 90 days or longer. In oligomenorrhea (infrequent menses) the interval is greater than 37 days but less than 90. Polymenorrhea (frequent menses) refers to a menstrual interval of less than 21 days. Bleeding related to the cycle may be abnormal in timing, duration, or quantity. It ends with the menopause, or cessation of menses, generally between age 45 and 50 years.Ībnormal vaginal bleeding may occur in association with or independent from menstruation. Normal vaginal bleeding occurs with the female ovulatory cycle beginning with the menarche, or onset of menses, which generally occurs at 10 to 15 years of age.
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