Template:Non pregnant vaginal bleeding treatment

Mild Bleeding

• Iron supplementation
• Ibuprofen
  • For cramps and can theoretically decreases intra-uterine bleeding

Moderate continued bleeding

Patients can benefit from initiation of birth control or for acute cessation consider medroxyprogesterone therapy in the ED

• Medroxyprogesterone
  • Give only if endocervical curettage/endometrial biopsy does not need to be performed (young patient) or has already been performed, since the hormone may alter the results
  • High Dose regimen: 150mg IM x 1 then 20mg PO Q8hrs x 3 days
  • In a trial of 48 patients all had cessation in 5 days.
  • Alternative regimen: 10mg PO q8 x 7 days then 10mg daily x 3 weeks

Life Threatening

• Establish large bore IV access
• Prepare for emergent blood transfusion uncrossmatched O-negative blood if typed blood is not available.
• It is possible to temporize bleeding w/ intravaginal packing with kerlix soaked in with thrombin
• If bleeding is due to a traumatic cause emergent surgical repair is necessary
• Tranexamic acid
  • Coordinate with OBGYN prior to administration due to the increased thrombotic risk
  • Acutely 10 mg/kg IV, max dose of 600 mg
  • Then 1-1.5 g TID PO for 5 days