	no number cut off - this is heavy bleeding that is affecting pt's life
Etiology	Structural causes (PALM): polyps, adenomyosis, leimyoma (fibroids), malignancy Non-structural (COEIN): coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise specified Non-uterine causes: hypothyroidism, trauma, Pelvic inflammatory disease
Clinical presentation	Shocked? Pregnant?
Diagnostic investigations	Pregnancy test VBG, FBC, clotting screen TVUS
Management	Resuscitation: Impending bleeding doom, IV oestrogen??? Stable patient: Mefanemic acid, TXA, COCP/POP/IUD

you can use blood on the POCT pregnancy test machine????

relevant history


History of the Vaginal Bleeding	- Frequency and duration - Volume is difficult to quantify but the presence of clots and/or the need to change tampons/pads more often than every 3 hours suggests HMB1,17 - Impact on activities and quality of life8
Gynaecological and Obstetric History	- Date of the first day of the last menstrual period (LMP) - History of her typical menstrual cycle - Pregnancies/miscarriages/stillbirths/terminations - Gynaecological procedures/surgeries - Sexually transmitted infections - Smear tests and results
Bleeding History	- Spontaneous bruising or bleeding from mucous membranes - Significant bleeding after previous delivery, tooth extraction, surgery - Family history
Associated Symptoms	- Abdominal/pelvic pain/pressure - Symptoms of anaemia e.g. dyspnoea, fatigue - Symptoms of infection e.g. fever, dysuria, malodorous/abnormal discharge - Symptoms of systemic endocrine disorder e.g. Hirsutism in PCOS

sources/links