Don't Ovary Act

Your next patient is a healthy 35-year-old female presenting for evaluation of a "heavy period." She states she can't possibly be pregnant, and has no known bleeding disorders, or any other medical history. Her vitals are stable and within normal limits. Don't over react! Heavy vaginal bleeding in the nonpregnant patient is a common emergency department complaint. Below: a basic review of diagnosis, management, and treatment.

For a quick on-shift reference you are welcome to download your own PDF.


•Effect Of Treatment Delay On The Effectiveness And Safety Of Antifibrinolytics In Acute Severe Haemorrhage: A Meta-Analysis Of Individual Patient-Level Data From 40138 Bleeding Patients Gayet-Ageron, A., et al, Lancet Epub ahead of print, November 7, 2017

•Cameron A, Menticoglou S. Blood Pressure Cuff Tamponade of Vaginal Lacerations Causing Significant Postpartum Hemorrhage. J Ostet Gynaecol Can 2011;33(12)1207

•Pinborg A, Bodker B, Hogdall C. Postpartum hematoma and vaginal packing with a blood pressure cuff. Acta Obstet Gynecol Scand 2000;79:887-9.

•Conti, C.R., Is menstruation a contraindication to thrombolytic therapy. Clin Cardiol 15:625, 1992

•Wein TSH et al. Safety of tissue plasminogen activator for acute stroke in menstruating women. Stroke 2002 Oct;33(10):2506-8

•Marret, H., et al, Clinical Practice Guidelines on Menorrhagia: Management of Abnormal Uterine Bleeding Before Menopause. Eur J Obstet Gyn Reprod Biol 152(2):133, October 2010

•ACOG Committee Opinion. Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women.

•Kouides PA, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril 2005;84:1345–51.

•The Utility Of Routine Ultrasound In The Diagnosis And Management Of Adolescents With Abnormal Uterine Bleeding Pecchioli, Y., et al, J Pediatr Adolesc Gynecol 30(2):239, April 2017

•Peitsidis P, Kadir RA. Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother 2011 Mar;12(4):503-16.

•Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006 Oct;108(4):924-9.

•Kriplani A, Kulshresthea V, Agarwal N, Diwakar S. Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate. J Obstet Gynaecol. 2006 Oct;26(7):673-8.

•Freeman EW, Lukes A, VanDrie D, Mabey RG, Gersten J, Adomako TL. A dose-response study of a novel, oral tranexamic formulation for heavy menstrual bleeding. Am J Obstet Gynecol. 2011 Oct;205(4):319.e1-7.

•Jones JS, Rossman L, Hartman M, Alexander CC. Anogenital injuries in adolescents after consensual sexual intercourse. Acad Emerg Med. 2003 Dec;10(12):1378-83.

•Doroudi M, Kramer BS, Pinsky PF. The bimanual ovarian palpation examination in the Prostate, lung, Colorectal and Ovarian cancer screening trial: Performance and complications. J Med Screen. 2017 Dec;24(4):220-222.

•Roy SN, Bhattacharya S. Benefits and risks of pharmacological agents used for the treatment of menorrhagia. Drug Safety 2004;27(2):75‐90.

•Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019 Feb 11;2:CD00154.

•Padilla LA, Radosevich DM, Milad MP. Limitations of the pelvic examination for evaluation of the female pelvic organs. Int J Gynaecol Obstet. 2005 Jan;88(1):84-88.

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Important: If you think you have a medical emergency, call 911 or go to the nearest hospital. The views expressed on this site are my own. Do not attempt emergency care through this site. The intended audience for this site is other emergency medicine physicians in an educational setting, and the information contained on this website provides general information for educational purposes only; it is not a substitute for medical or professional care. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. I am not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site. The views expressed on this site should not be considered complete or exhaustive, nor should you exclusively rely on such information to recommend a course of treatment for you or any other individual.