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 ED visits are for vaginal bleeding, and 1% of those patients will have a life-threatening cause that must be identified. Emergency clinicians need to have a comprehensive understanding of the pathophysiology and etiologies of abnormal uterine bleeding to manage and treat these patients. This issue reviews the most recent updates on common causes and the approach to abnormal uterine bleeding in the nonpregnant patient, including vaginal bleeding in prepubescent females.
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1. * Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408. (Practice guidelines) DOI: 10.1002/ijgo.12666
2. * Levy-Zauberman Y, Pourcelot AG, Capmas P, et al. Update on the management of abnormal uterine bleeding. J Gynecol Obstet Hum Reprod. 2017;46(8):613-622. (Practice guidelines) DOI: 10.1016/j.jogoh.2017.07.005
23. * Borhart J. Emergency department management of vaginal bleeding in the nonpregnant patient. Emerg Med Pract. 2013;15(8):1-20. (Review)
29. * Bofill Rodriguez M, Lethaby A, Low C, et al. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;8(8):CD001016. (Cochrane review; 15 randomized controlled trials, 1071 women) DOI: 10.1002/14651858.CD001016.pub3
45. * Lopez HN, Focseneanu MA, Merritt DF. Genital injuries acute evaluation and management. Best Pract Res Clin Obstet Gynaecol. 2018;48:28-39. (Review) DOI: 10.1016/j.bpobgyn.2017.09.009
47. * Lethaby A, Hussain M, Rishworth JR, et al. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015(4):CD002126. (Cochrane review; 21 randomized controlled trials, 2082 women) DOI: 10.1002/14651858.CD002126.pub4
Keywords: uterine, vaginal, bleeding, menstrual, nonpregnant, estrogen, progesterone, progestin, PALM-COEIN, von Willebrand, polyp, fibroid, adenomyosis, leiomyoma, PCOS, malignancy, intrauterine device, IUD, oral contraceptive pill, OCP, Chlamydia, anemia, thrombocytopenia, ultrasound, packing, tranexamic acid, transfusion, NSAID, anticoagulant, DOAC, FGM, levonorgestrel, LNG-IUS, elagolix
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In This Episode
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Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the August 2021 issue of Emergency Medicine Practice: Emergency Department Management of Abnormal Uterine Bleeding in the Nonpregnant Patient
Tazeen Abbas, MD; Abbas Husain, MD, FACEP
Jacob Arnold, MD; Ashley Booth Norse, MD, FACEP
August 1, 2021
August 31, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
Date of Original Release: August 1, 2021. Date of most recent review: July 10, 2021. Termination date: August 1, 2024.
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