›Hemorrhage stabilization bundle
›Crystalloid judicious use
›Bridge while blood prepared
›Avoid dilutional coagulopathy in massive hemorrhage
›RBC transfusion
›If hemodynamic instability from bleeding
›If symptomatic anemia with ongoing bleeding
›Platelets and plasma support per massive hemorrhage protocol
›If thrombocytopenia or coagulopathy
›If large volume transfusion
›Tranexamic acid early in life-threatening bleeding
›1 g IV over 10 minutes
›Then 1 g IV over 8 hours if ongoing bleeding
Medical hemostatic therapy for abnormal uterine bleeding
›Hormonal acute control options
›High-dose combined oral contraceptive regimen
›Ethinyl estradiol 30 to 35 mcg with progestin
›1 tablet PO every 6 hours for 24 hours
›Then 1 tablet PO every 8 hours for 3 days
›Then 1 tablet PO daily
›Contraindications screen
›VTE history
›Migraine with aura
›Severe hypertension
›High-dose progestin regimen
›Medroxyprogesterone acetate 20 mg PO every 8 hours for 7 days
›Then 20 mg PO daily for 21 days
›Useful when estrogen contraindicated
›Norethindrone acetate 5 mg PO every 6 hours for 7 days
›Then taper per outpatient plan
›Alternative progestin strategy
›IV estrogen for refractory severe uterine bleeding with gynecology involvement
›Conjugated estrogen 25 mg IV every 4 to 6 hours
›Maximum 24 hours total
›Transition to oral hormonal regimen after control
›Thrombosis risk mitigation
›Avoid in high VTE risk
›Consider hematology input if needed
›Antifibrinolytic and anti-inflammatory options
›Tranexamic acid for stable heavy bleeding
›1 g PO three times daily during heavy days
›Avoid in active thrombosis
›NSAIDs for ovulatory heavy menstrual bleeding
›Ibuprofen 400 mg PO every 6 hours with food
›Naproxen 500 mg PO once then 250 mg PO every 6 to 8 hours
›Iron repletion when anemia present
›Ferrous sulfate 325 mg PO every other day
›IV iron pathway when oral not tolerated or severe deficiency
Procedural and definitive hemorrhage control
›Mechanical and procedural options
›Intrauterine balloon tamponade for uncontrolled uterine bleeding
›Foley catheter with sterile water inflation
›Gynecology guidance and monitoring
›Dilation and curettage or hysteroscopy for persistent bleeding
›Suspected retained products or focal lesion
›Hemodynamic compromise despite medical therapy
›Uterine artery embolization in select refractory cases
›Interventional radiology pathway
›Structural bleeding source or failed medical therapy
Treat the underlying cause
›Infection related bleeding
›Cervicitis treatment per local STI guideline
›Ceftriaxone IM single dose regimen per local dosing
›Doxycycline regimen per local dosing
›PID treatment per local guideline
›Broad coverage outpatient or inpatient pathway based on severity
›Admission for systemic illness or inability to tolerate PO
›Anticoagulant associated bleeding
›Hold anticoagulant and coordinate with prescriber
›Risk benefit discussion
›Restart planning after control
›If life-threatening bleeding, reversal pathway per agent
›PCC based strategy for warfarin or factor Xa inhibitors per local protocol
›Vitamin K for warfarin based on INR and severity
›Coagulopathy
›Hematology involvement when suspected inherited bleeding disorder
›Desmopressin for known type 1 von Willebrand disease per protocol
›Factor concentrate pathway for severe disease