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Everyone must stay at home to help stop the spread of coronavirus. Advice for clinicians on COVID-19 (coronavirus) is here. If you are a member of the public looking for health advice, visit the NHS website or North Yorkshire Public Health. And if you are looking for the latest travel information, and advice about the government response to the outbreak, go to the website.

Last updated: 30 March, 2020 15:59pm

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Intermenstrual bleeding – Information for GPs


Vaginal bleeding (other than post coital) at any time in the cycle other than during normal menstruation.

Red flag symptoms

  • Postmenopausal bleeding (PMB) i.e. bleeding >12 months after last period
  • Persistent Intermenstrual Bleeding (IMB) if >45 or other risk factors for endometrial cancer (e.g. obesity, PCOS unopposed estrogen, tamoxifen)
  • Suspicious cervix on examination
  • If more than episodes of IMB; organise swabs/examination and USS
  • Remember chlamydia in under 25s
  • If any abnormality on USS or examination – consider referral
  • If swabs and USS normal – trial of treatment; Mirena/COCP/POP/Tranexamic acid

Failure to respond to standard therapy – consider referral for hysteroscopy

Investigations prior to referral

  • Chlamydia screening
  • High vaginal swab
  • Pelvic USS
  • NB: DON’T perform a cervical smear if outside the screening programme

Information to include in referral letter

  • Describe problem and length of symptoms
  • Current contraception/hormone therapy
  • Speculum findings (e.g. normal/ectropion/cervicitis/cervical
  • Smear history (including last smear & result) – the patient will still be seen without this but if you can retrieve it automatically it speeds up the consultation
  • Swab results
  • USS result
  • Relevant past medical / surgical history
  • Current regular medication
  • BMI / Smoking status

Desirable information

Treatments tried so far if on hormonal contraception

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