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C3 - Non Pregnant Vaginal Bleeding - Management

Mel Herbert, MD MBBS FAAEM, Stuart Swadron, MD, FRCPC, Mizuho Spangler, DO, and Jessica Mason, MD

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C3 - Non Pregnant Vaginal Bleeding Written Summary 420 KB - PDF

Management of the stable patient.

Non-pregnant Vaginal Bleed - Management

Stuart Swadron MD, Mizuho Spangler DO, and Mel Herbert MD


* Drug doses are a guide only, always check second source and follow local practice guidelines


Stable patients

      Treatment options

      D & C (dilatation and curettage by OB/Gyn in OR)

      Hormonal therapy

      How does hormonal therapy work to stop bleeding?

      Estrogen works by causing further proliferation of the endometrial lining, arresting the sloughing process

      Progestin works by stabilizing the existing endometrial lining

      When progestin is stopped (after several days daily oral therapy) patients should expect an initial heavy prolonged period.  This is because they most often have anovulatory bleeding and thus an abnormal buildup of the endometrial lining from unopposed estrogen 

      Typically 2 options:

      OC (oral contraceptives) combined estrogen/progestin

      Progestin only pills when estrogen contraindicated

      Estrogen contraindicated in:

      Patients with history of thrombosis (MI, DVT, PE)

      Cancer or cancer not ruled out

      Patients who are trying to get pregnant

      OCP doesn’t work for contraception first month

      Treatment for anemia

      Iron (Fe) supplementation

      Vitamin C (helps with Fe absorption)


      Prostaglandin inhibitors

      Decreases cramping pain and bleeding by 50%

      Endometrial Biopsy

      Important for peri- and post-menopausal patients as well as those with high risk for endometrial cancer such as patients with anovulatory bleeding (unopposed estrogen)

      Usually done by OB/Gyn, can be done as outpatient

      Discuss with OB/GYN/primary MD after evaluation


      Decision to keep patient in hospital for a D & C versus using medical therapy only depends on multiple factors including the patient’s condition, briskness of bleeding, availability of timely follow-up and patient preference


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C3 - Non Pregnant Vaginal Bleeding Full episode audio for MD edition 49:18 min - 57 MB - M4AC3 - Non Pregnant Vaginal Bleeding Written Summary 420 KB - PDFC3 - October MP3s 62 MB - ZIPC3 - October - Non Pregnant Vaginal Bleeding - Board Review Answers 174 KB - PDFC3 - October - Non Pregnant Vaginal Bleeding - Board Review Questions 132 KB - PDF