ABSTRACT
The two commonest causes of abnormal vaginal discharge in primary care are bacterial vaginosis (BV) and candida. BV is more common than candida but under-diagnosed, candida is over-diagnosed and over-treated. Microscopy is the most reliable way to make a diagnosis, but it is unlikely to be available in primary care. Caused by an overgrowth of anaerobic bacteria in the vagina at the expense of the normal commensal lactobacteria. A change in pH or hormone balance, or a course of broad spectrum antibiotic, may trigger yeast multiplication and symptoms. Heavy Menstrual Bleeding is a common problem; in 50% of women, no underlying cause can be found. Possible diagnoses include fibroids and endometriosis. Vomiting and persistent, severe diarrhoea can interfere with the absorption of combined oral contraceptives. A woman whose period is due when she is on holiday, or taking part in a religious or sporting event, may request medication to delay her period.
