For clinicians
Physicians, nurse practitioners, and physician assistants can speak directly with an OB/GYN about a patient with abnormal uterine bleeding, or refer the patient for telehealth management.
Doctor-to-doctor consult line
Monday to Friday, 11 a.m. to 11 p.m. Eastern. Saturday and Sunday, 11 a.m. to 9 p.m. Eastern.
Common consult questions
- Stabilizing acute bleeding in an outpatient who does not need admission
- Sequencing the workup, and when an endometrial biopsy is indicated
- Choosing hormonal therapy for a patient with cardiovascular, thrombotic, or other risk factors
- Suspected bleeding disorder in an adolescent
- Selecting medical therapy for symptomatic fibroids
- Postmenopausal bleeding triage
Refer a patient
We see patients by telehealth in all 50 states, order local labs and imaging, and coordinate in-person procedures. To refer a patient, call the line above.
Hemodynamically unstable bleeding belongs in the emergency department. Call us after the patient is en route if you would like to discuss.
Quick reference
Endometrial sampling is indicated for
- AUB at age 45 or older
- AUB before 45 with a history of unopposed estrogen exposure, such as obesity or PCOS
- Failed medical management or persistent AUB
- Postmenopausal bleeding with an endometrial thickness over 4 mm, a poorly visualized endometrium, or persistent bleeding
Acute AUB, nonpregnant, hemodynamically stable
Regimens described in ACOG Committee Opinion 557 include:
| Agent | Regimen described | Key cautions |
|---|---|---|
| Conjugated equine estrogen | 25 mg IV every 4–6 hours for up to 24 hours | Contraindicated with thrombosis risk |
| Monophasic combined oral contraceptive (35 mcg ethinyl estradiol) | One tablet three times daily for 7 days | Estrogen contraindications |
| Medroxyprogesterone acetate | 20 mg orally three times daily for 7 days | Nausea, mood |
| Tranexamic acid | 1.3 g orally three times daily for 5 days, or 10 mg/kg IV (max 600 mg) | Active or prior thromboembolism |
Verify against current guidance and product labeling. Bridge to long-term therapy and complete the PALM-COEIN evaluation.
Sources
- American College of Obstetricians and Gynecologists. Committee Opinion No. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891–896 (reaffirmed).
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 128: Diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206 (reaffirmed).
- American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124–e129.