Urgent Care Management of Abnormal Uterine Bleeding in the Nonpregnant Patient

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Publication Date: September 2024 (Volume 3, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 09/01/2027.

Author

Peer Reviewer

Abstract

Uterine bleeding that is abnormal in timing, duration, or quantity affects nearly one-third of women and carries a substantial financial and quality-of-life burden. An estimated 5% of emergency visits are for vaginal bleeding, and 1% of those patients will have a life-threatening cause that must be identified. These patients may also present to urgent care, and urgent care clinicians need to have a comprehensive understanding of the pathophysiology and etiologies of abnormal uterine bleeding to effectively manage these patients. This issue reviews the common causes and clinical approach to abnormal uterine bleeding in nonpregnant patients from prepubescence through menopause.

Case Presentations

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…

An 18-year-old girl with heavy vaginal bleeding with the passage of blood clots for the past 4 hours walks into the urgent care…

• The patient appears pale and weak and her heart is racing. Her mother says that she almost fainted on the way over. Your staff becomes anxious when they see this young patient come into the urgent care.
• She tells you that she began spotting 1 week prior, but the bleeding has become acutely worse. Her mother notes that the patient told her that she had a nosebleed a few days ago.
• You quickly assess the patient and consider a treatment plan to best care for this patient…

A 55-year-old postmenopausal woman presents to the urgent care with an episode of bright red vaginal bleeding…

• She has been taking hormone replacement therapy for the last year but has not had any problems.
• Her medical history is remarkable for obesity, hypertension, and diabetes.
• Initial assessment in the urgent care reveals stable vital signs. An abdominal examination is normal. The pelvic examination is remarkable for a small amount of old blood in the vaginal vault with no other abnormalities of the cervix or vagina.
• The bimanual examination reveals a small nontender uterus with no adnexal masses or tenderness.
• You consider the best course of action for this patient, considering her risk factors and clinical presentation...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.