Iron supplementation
324mg ferrous sulfate tablet PO TID (each tab contains 65mg of elemental iron)
Ibuprofen
For cramps and can theoretically decreases intra-uterine bleeding
Reduces endometrial prostaglandin levels and promotes vasoconstriction in the uterus
324mg ferrous sulfate tablet PO TID (each tab contains 65mg of elemental iron)
For cramps and can theoretically decreases intra-uterine bleeding
Reduces endometrial prostaglandin levels and promotes vasoconstriction in the uterus
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
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
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 1.0-1.3 grams IV
Then 1-1.3 g TID PO for 5 days
Coordinate with OBGYN prior to administration due to the increased thrombotic risk
Acutely 1.0-1.3 grams IV
Then 1-1.3 g TID PO for 5 days
Nonpregnant vaginal bleeding
Systemic Causes
Vaginal bleeding in pregnancy 
Cirrhosis
Prepubertal vaginal bleeding
Coagulopathy 
Abdominal pain in pregnancy
Group A strep vaginitis 