16yo girl to ER b/o heavy vaginal bleeding.No pain. Since mernache the menses 's been irregular.Vital signs r in normal limit. PE: continuous vaginal bleeding.Pregnancy test neg.Coagulation study normal. U/S normal. Most appropriate next step in Mx?
a.Emergency dilatation & curretage
b. High dose Medproxyprogesterone
c. Conjugated Estrogen
d. Hysteroscopy
e. High dose GnRH agonist
Could u pls explain why. Thanks.
as estrogen req for growth of vasculature in endometrium and any bleeding can be stopped by estrogen immediately.........so in any gynecological case of profuse bleeding...to stop it best Rx is Estrogen.
weak endometrial bleed because blood vessel in it have no support and they bleed during the later part of menstruation due to low level of progesterone and estrogen. when there is bleeding there is menstruating like stage . when we give estrogen it comes to the first proliferative phase of endometrium when endometrial hyperplasia occur that will support the blood vessel so that they donot keep on rupturing and eventually bleeding will stop
Thanks for the ans. What is your dx, Djyoti?
Now, the bleeding stop after IV estrogen. What is the next appropriate step?
a. endometrial biopsy
b. Hysteroscopy
c. Colposcopy
d. Progestin withdral test
e. Combined OCP to mimic natural menstrual cycle