- C3 - Non Pregnant Vaginal Bleeding - Introduction13:40C3 - Non Pregnant Vaginal Bleeding - History13:37C3 - Non Pregnant Vaginal Bleeding - Management12:36C3 - Non Pregnant Vaginal Bleeding - Unstable9:25
C3 - Non Pregnant Vaginal Bleeding - Management
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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
● 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