What’s Your Diagnosis? ED Management of Abnormal Uterine Bleeding in the Nonpregnant Patient
July 12, 2021
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
Case Presentation: Emergency Department Management of Abnormal Uterine Bleeding in the Nonpregnant Patient
A 29-year-old woman presents with vaginal bleeding for 3 weeks…
- The patient states that she has been unable to get an appointment with her gynecologist until the end of the week, and she is concerned over the increasing blood loss. She has a history of irregular menstrual periods, and she was having intermittent spotting that has become heavier, with clots, over the past 5 days. She is using multiple pads a day.
- In triage, her vital signs are within normal limits. You order a pregnancy test, which is negative.
- You wonder whether and how you should begin treatment, or whether you should do nothing and defer to her gynecologist…
You noted that she had blood in the vaginal vault that was originating from the cervical os. The rest of her examination was within normal limits. You ordered a CBC, and her hemoglobin was 13 g/dL. You determined she was having an episode of anovulatory bleeding and ensured she had no contraindications to estrogen before prescribing a short taper of oral contraceptives (1 OCP 3 times/day for 7 days, then 1 pill/day until the pack is finished). Additionally, you recommended she ask her gynecologist about the LNG- IUS when she follows up with her at the end of the week.
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