Pediatric emergency medicine trisk 2157 2157

Mild
(Hgb >12
mg/dL)
Moderate
(Hgb 10–12
mg/dL)

Severe
(Hgb <10
mg/dL)

May monitor as an outpatient
Offer OCPs or progestin-only pills
Ethinyl estradiol 0.03 mg/norgestrel 0.3 mg OCP every 6 hrs
until bleeding stops. Then pills may be tapered if the
bleeding has not resumed to three pills a day for 3 days, two
pills a day for 3 days, then one pill daily
If estrogen is contraindicated, then may use
medroxyprogesterone 10 mg or norethindrone acetate 5–10
mg up to four times a day. May give four times a day for 4
days, then taper to three times a day for 3 days, then two
times a day for 2 wk. Follow-up will be needed by her
outpatient provider
Iron 65 mg/day and consider a stool softener
Antiemetics as needed
Follow-up as outpatient with primary care provider, adolescent
medicine, gynecologist, or hematology
Assess for hemodynamic instability
Volume resuscitation and consider blood transfusion
If bleeding is severe and poorly controlled, consider conjugated
estrogen (Premarin) 25 mg IV every 4 hrs for 2–3 doses

Otherwise, most patients respond to ethinyl estradiol 0.05
mg/norgestrel 0.5 mg OCP every 6 hrs until bleeding stops.
Then pills may be tapered if the bleeding has not resumed to
three pills a day for 3 days, two pills a day for 3 days, then
one pill daily
If estrogen is contraindicated, then may use
medroxyprogesterone 10 mg or norethindrone acetate 5–10
mg up to four times a day. May give four times a day for 4
days, then taper to three times a day for 3 days, then two
times a day for 2 wk. Follow-up will be needed by her
outpatient provider
Antiemetics as needed
Iron 65 mg/day and consider a stool softener
Rarely, curettage if hormonal therapy fails