Menstruation, or period, is a woman’s monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It could be bleeding that is between periods, is very heavy, or lasts much longer than usual. It also includes bleeding that happens before puberty or after menopause. Causes can include:

• Uterine fibroids or polyps
• Hormone problems
• Hormone pills, such as birth control pills and hormone replacement therapy (menopausal hormone therapy)
• Cancer of the cervix, ovaries, uterus or vagina
• Thyroid problems

Assessment and Management

Performing a primary survey will ensure that the patient’s need for oxygen or presence of shock. Bleeding can be controlled with direct pressure over the vagina with force either applied by the patient or rescuers. Shock is identified in patient with no radial pulse or hypotension. Management of shock includes high flow oxygen, preventing heat loss (with a blanket), and elevating the feet. If the patient is experiencing pain, the medics should make note of the location of the pain. This can be helpful in determining hospital destination or eventual diagnosis at the hospital.