October 2016


Non-Pregnant Vaginal Bleeding4 Chapters

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Adam N. PA-C MS -

What are your guys favorite "go to" oral contraceptives and regimens when discharging a stable heavy vaginal bleeder? There are so many choices and it can become confusing on which ones to Rx . Will any of them do the job? Do you start them 1 tab per day or do you double up first few days etc? Do you give them just 1-2 weeks worth of do you give 30 days worth? Also if they are already on oral birth control can we tell them to double the dose for a few days? I rarely rx oral contraceptives and when I do feel slightly uncomfortable since I don't do it often. Thanks!

Sean G., M.D. -

Excellent piece. This has always been an area of discomfort for me...confusion about the when and why of hormone Rx and which ones to Rx...two questions despite listening 4 times....with the brick and mortar analogy why does adding an estrogen supplement stop bleeding if it results in more building of a wall without mortar....wouldn't that just create more bleeding since the unstable wall is just getting bigger? Second what is the whole issue with the endometrial bx. Most of the time I can not reach an OB at 3 am who will say anything other than...if she is "stable" dont start anything and have her call the office in the morning to arrange follow up" Not to comforting. I would prefer to start the hormones...does starting OCP actually hinder the endometrial bx accuracy?

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