EMplify - September 2021
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Abnormal Uterine Bleeding in the Emergency Department
Authors:
Tazeen Abbas, MD
Abbas Husain, MD, FACEP


Physiology review 
Terminology
Differentiating Causes: PALM-COEIN

Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia
Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified
Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise


Age Based Differential

12-18

Immaturity of the hypothalamic-pituitary- ovarian axis 
Sexually transmitted infections
Coagulopathies, and bleeding disorders (von Willibrand disease)


19-39

polyps
fibroids
malignancy 
PCOS


Age 40 and older

endometrial atrophy
malignancy




History
Physical Exam
Diagnostic Studies
Treatment

Unstable
Stable


Special Cases

DOACs
Prepubescent girls
genital injuries

Episode 61 – Abnormal Uterine Bleeding

Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!

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Episode 61 – Abnormal Uterine Bleeding

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