Template:Non pregnant vaginal bleeding treatment
Mild Bleeding
- Iron supplementation
- 324mg ferrous sulfate tablet PO TID (each tab contains 65mg of elemental iron)
- Ibuprofen
- For cramps and can theoretically decreases intra-uterine bleeding
- Reduces endometrial prostaglandin levels and promotes vasoconstriction in the uterus
Moderate continued bleeding
Patients can benefit from initiation of birth control or for acute cessation consider medroxyprogesterone therapy in the ED
- Medroxyprogesterone
- Give only if endocervical curettage/endometrial biopsy does not need to be performed (young patient) or has already been performed, since the hormone may alter the results
- High Dose regimen: 150mg IM x 1 then 20mg PO Q8hrs x 3 days
- In a trial of 48 patients all had cessation in 5 days.[1]
- Alternative regimen: 10mg PO q8 x 7 days then 10mg daily x 3 weeks[2]
Life Threatening
- Establish large bore IV access
- Prepare for emergent blood transfusion uncrossmatched O-negative blood if typed blood is not available.
- It is possible to temporize bleeding w/ intravaginal packing with kerlix soaked in with thrombin
- If bleeding is due to a traumatic cause emergent surgical repair is necessary
- Tranexamic acid [3]
- Coordinate with OBGYN prior to administration due to the increased thrombotic risk
- Acutely 1.0-1.3 grams IV
- Then 1-1.3 g TID PO for 5 days
Pharmacologic Treatment Regimens For Acute Abnormal Uterine Bleeding[4][5]
| Drug | Suggested Dose | Contraindications |
| Conjugated equine estrogen | 25 mg IV every 4-6 h until bleeding stops, up to 24 h | Active or past thromboembolic disease, breast cancer, or liver disease |
| Combination oral contraceptive pills | 1 pill tid PO for 7 days or 1 pill bid PO for 5 days, then 1 pill qd until pack is finished | > 35 y who smoke, hx of DVT or PE, breast cancer, liver disease, known thromboembolic disorders, pregnancy, ischemic heart disease, cerebrovascular disease, or uncontrolled hypertension |
| Progestin-only oral contraceptive pills (medroxyprogesterone acetate) | 20 mg tid PO for 7 days or 10 mg qd PO for 10 days | Active or past DVT or PE, liver disease, or breast cancer |
| NSAIDs: Ibuprofen | 200-400 mg 3-4 times/day PO for 5 days | Advanced renal disease |
| Antifibrinolytic agents (tranexamic acid) | 1.3 g tid PO for up to 5 days | Active intravascular clotting or subarachnoid hemorrhage |
- ↑ Ammerman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute, abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013. 208(6):499.e1-e5.
- ↑ Aksu F, Madazli R et al. High-dose medroxyprogesterone acetate for the treatment of dysfunctional uterine bleeding in 24 adolescents. Aust N Z J Obstet Gynaecol. 1997;37(2):228–231.
- ↑ Leminen and Hurskainen. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health. 2012; 4: 413–421.
- ↑ American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 557: management of acute abnormal uterine bleeding in nonpregnant reproductiveaged women. Obstet Gynecol. 2013;121(4):891-896
- ↑ Tibbles CD. Selected gynecologic disorders: abnormal uterine bleeding in the nonpregnant patient. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby-Elsevier; 2010: 1325-1332.