Www.gpone.wales.nhs.uk
Investigation of abnormal vaginal bleeding
Cervical screening should not be performed for a woman under 25 who has not been invited for screening, whether she has symptoms or not. Screening women under 25 is ineffective at cancer prevention and may cause more harm than benefit.
Cervical screening should not be performed for a woman over the age of 64 if she has not been invited for screening unless she has never had a test.
Cervical screening is not a diagnostic test and therefore not appropriate to investigate symptoms.
Cervical cancer in women under 25 is uncommon, however, in a significant proportion of these cases there can be a delay in diagnosis. Common symptoms of abnormal vaginal bleeding may be thought to be due to dysfunctional bleeding, or related to oral contraceptive use.
The main symptoms of cervical cancer are: -
• recurrent postcoital bleeding
• persistent intermenstrual bleeding
• post-menopausal bleeding
• prolonged unusual vaginal discharge
Any of these symptoms requires investigation. All women presenting with postmenopausal bleeding must be referred as an ‘urgent suspected cancer’.
The most important investigation in the early diagnosis of cervical cancer is an immediate speculum examination to assess the cervix. Women with postcoital bleeding or persistent intermenstrual bleeding must be offered a speculum examination either in primary care or at a Sexual Health clinic
Consideration should also be given to other causes, e.g. infection or pregnancy, and relevant testing performed where appropriate.
If the cervix looks abnormal and suspicious, the correct action is urgent referral to colposcopy/gynaecology (depending on local arrangements) as an ‘urgent suspected cancer’.
If there is a benign lesion, such as cervical polyp, a routine gynaecological referral will be adequate.
If the cervix looks normal and all tests have come back normal but abnormal bleeding persists refer to gynaecology.
If the cervix cannot be seen due to persistent abnormal bleeding refer into gynaecology.
Women who have repeated cancelled cervical screening tests due to irregular bleeding should have an appointment at the GP surgery or Gynaecology department for examination. Staff booking or cancelling appointments should be made aware of this.
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