Hemodynamically stable reproductive-age patient with acute uterine bleeding: Initial management

Acute uterine bleeding in a reproductive-aged patient refers to bleeding that is either profuse or prolonged and may be an isolated or recurrent event. Treatment of the underlying condition (eg, submucosal fibroid, bleeding disorder, endocrine abnormality), if present, may prevent the episode from recurring. Hemodynamically unstable patients are managed differently; refer to related UpToDate content.

D&C: dilation and curettage; UAE: uterine artery embolization; OC: oral contraceptive.

* Estrogen therapy is contraindicated in patients at high risk for venous thromboembolism and coronary or cerebral thrombosis; progestin therapy is also contraindicated in some patients. This is discussed in detail in related UpToDate content.

¶ UAE may be used as an alternative to D&C in some patients (eg, suspected arteriovenous malformation).

Δ An endometrial specimen should be collected prior to hormonal therapy, whenever possible. D&C may be performed in patients who prefer to avoid hormone therapy.

◊ Other regimens may be used and are discussed in related UpToDate content.

§ Pregnancy is contraindicated following endometrial ablation and patients must be counseled that contraception is necessary following the procedure.

¥ UAE or D&C may be used as an alternative to endometrial ablation in patients with a submucosal fibroid(s).

‡ The safety of pregnancy after UAE is uncertain and may be associated with adverse outcomes (eg, miscarriage, preterm birth, placental problems, malpresentation); refer to related UpToDate content.

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Hemodynamically stable reproductive-age patient with acute uterine bleeding: Initial management