ED Treatment of 

Abnormal Uterine Bleeding 

Hemodynamically unstable 
Resuscitation 
 • ABCs! 
 • Fluids + blood transfusion 
 • Correction of any underlying coagulopathy 
Pregnancy test rule out possible ectopic vs pregnancy related cause 
 Hemorrhage control 
 • IV conjugated estrogen: 25mg Q4-6H 
 • Transexamic acid (PO or [V) 
 • Intrauterine tamponade with 26 French catheter with 30cc saline 
 • Avoid vaginal packing - increased risk of infection, obscures ongoing hemorrhage 
 • Medroxyprogesterone acetate PO 
Stat GYN consult or transfer for GYN care 

Hemodynamically stable 
NSAIDs 
Monophasic combined oral contraceptives: TID for 7 days 
 • Contraindications: thromboembolic disease, breast cancer, liver dysfunction, smokers aged 

> 35 years, cardiovascular disease 
Progestin-only contraceptive: TID for 7 days 
 • Use especially if concern for endometrial path0100' or breast cancer 
 IM progestin xl in ED with 3 day course of PO 
 Outpatient OBGYN follow-up for long-term therapy 


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