A 15-year-old girl presents with acute heavy menstrual bleeding, haemoglobin 6.8 g/dL, haemodynamically stable but symptomatic. Coagulation screen is being sent. Which is the most appropriate initial pharmacological measure to stop the bleeding?
- A Tranexamic acid 500 mg orally three times a day as monotherapy
- B Low-dose combined oral contraceptive pill once daily
- C Intravenous conjugated oestrogen 25 mg every 4 hours ✓
- D Medroxyprogesterone acetate 10 mg daily for 10 days
Correct answer: C. Intravenous conjugated oestrogen 25 mg every 4 hours
Explanation
Acute severe adolescent heavy menstrual bleeding with significant anaemia warrants intravenous conjugated oestrogen 25 mg every 4 to 6 hours until bleeding slows, followed by a combined oral contraceptive to maintain stability. Oral tranexamic acid or a single daily pill are insufficient for this degree of bleeding, and cyclic progestogen alone acts too slowly in acute heavy haemorrhage.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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