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Date Posted: 18:18:06 11/28/07 Wed
Author: Vancomycin
Subject: Re: Dark menstrual blood
In reply to: R 's message, "Dark menstrual blood" on 15:09:52 11/27/07 Tue

>A history of 2 weeks of dark menstrual blood, with
>small clots from time to time, normal volume of
>menstrual blood everytime, no associated pain.
>whats the DDx?

May I know her age?
Her last menstrual period?
Menarche (when does menses first start)?
Cycle? (regular/irregular)
Any intra-cycle bleeding/discharge?
Any dysmenorrhoea (painful menses)?
Any dyspareunia (painful intercourse)?
Any fertility problems/problems with previous pregnancy if any?
Any ultrasound investigation of pelvis (e.g. for fibroids)?
Any laproscopic exploration of pelvis?
Any par vaginal exam / pelvis exam?
Is she on any regular meds including the pill/injections?
Any similar problems in family?
Any injury to the abdomen/groin?

Sorry to ask so many questions... but blood clots can be anything from a stricture in the outlet of menses, to abnormal pregnancy, to endometriosis (outgrowth of uterine lining into adjacent (sometimes afar) structures, and to produce "menses" in the same way as the cycle itself--> the only problem is the outlet of the blood... that has to go somewhere and (often) presents as "blood clots" at the end of cycle/mid-cycle. Other ddx are fibroid/polyp, DUB, trauma and malignancy...

She should be referred to a gynaecologist if problem persists to rule out more detrimental problem (e.g. cancer)... especially to peri-menopausal women as endometrial carcinoma.

Good luck!

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