[Summary of the standard " XXXX " (first revision) of the Dutch College of General Practitioners].

@entity1 @entity1204 @entity3556 @entity5852 @entity548 @entity2622 @entity2692 @entity7828 @entity8376 @entity4134 @entity927 @entity1868 @entity1047
In the first revised version of the Dutch College of General Practitioners' practice guideline ' @entity3556 ' a distinction is made between excessive (cyclical), irregular, breakthrough and @entity548 . The diagnostic guidelines are aimed at identifying possible causes. However, in a considerable number of @entity1 no underlying cause is found and the @entity548 is assumed to be caused by hormonal fluctuations, for instance shortly after the menarche or premenopausal. Other causes can be: @entity1868 , an intra-uterine device (IUD), medication, or @entity1204 . Furthermore, lesions of the perineum, @entity8376 , a @entity4134 , @entity1047 , @entity2622 , imminent @entity5852 or ectopic pregnancy also have to be excluded. In this practice guideline, the management guidelines are limited to the treatment of @entity548 from the endometrium. In most cases @entity548 caused by hormonal fluctuations is self-limiting. However, symptomatic treatment with @entity7828 or sub-50 oral contraceptives is possible. NSAIDs taken during the first three days of menstruation are the second-choice treatment in @entity1 with excessive @entity548 . @entity927 or a @entity2692 -releasing IUD are other possibilities. Postmenopausal @entity1 with @entity3556 , first of all have to be examined by means of a cervical smear and transvaginal ultrasonography, to exclude an @entity1204 . They can initially be reassured if the ultrasonography reveals an endometrial thickness of 4 mm or less. In the case of persistent or recurrent @entity3556 , they should still be referred to a gynaecologist.
