Vaginal Bleeding

Abnormal vaginal bleeding during reproductive years

Post-menopausal bleeding

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Note:
Women should receive regular screening for cervical cancer after the age of 30 years. Any opportunity to perform screening should be taken; this includes taking pap smears during pregnancy.

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ABNORMAL VAGINAL BLEEDING DURING REPRODUCTIVE YEARS

N92.0-2/3-6

DESCRIPTION

Increased vaginal blood flow in either volume, duration, and/or frequency, including menorrhagia or dysfunctional uterine bleeding.

GENERAL MEASURES

• Assess current contraceptives used.
• Exclude pregnancy complication or organic disease e.g. cervical cancer, fibroids.

MEDICINE TREATMENT

• Combined oral contraceptive pill (ethinylestradiol/levonorgestrel) for 3–6 months.
• Ibuprofen, oral, 400 mg 8 hourly with or after a meal as needed for 2–3 days.
  • Ibuprofen may reduce blood loss in menorrhagia associated with intrauterine contraceptive device (IUCD) or chronic salpingitis (See: Sexually transmitted infections).

If blood loss has been severe or there are signs of anaemia:

• Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly with meals.

OR

• Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly
  • Continue for 3 months after Hb normalises - to replenish body iron stores
  • Taking iron tablets with meals decreases iron absorption, but improves tolerability

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Note:
Do not take iron tablets with milk

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LoE:IIb⁵³

REFERRAL

• No improvement.
• Girls < 12 years of age with vaginal bleeding before the development of their secondary sexual characteristics.
• For investigation of other causes such as:
  • sexual abuse
  • foreign bodies
  • tumours of the genital tract
• Severe anaemia.

POST-MENOPAUSAL BLEEDING

N95.0

DESCRIPTION

Vaginal bleeding six months following the complete cessation of menstruation.

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Note:
If bleeding is profuse, stabilise before referral.

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REFERRAL

All cases, to exclude underlying malignancy and other pathology.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.11 Vaginal Bleeding