A 13-year-old girl presents with 10 days of continuous heavy vaginal bleeding since menarche 8 months ago. Hemoglobin is 6.2 g/dL, pulse 118/min, blood pressure 96/60 mmHg, and she feels faint on standing. Bleeding is ongoing. The most appropriate immediate management is:

• A Combined oral contraceptive pill at low dose once daily orally
• B Intravenous conjugated equine estrogen 25 mg every 4 to 6 hours ✓
• C Tranexamic acid alone and iron supplementation, review in 4 weeks
• D Progestogen-only pill once daily orally

Explanation

Adolescents with severe anovulatory dysfunctional uterine bleeding who have significant anemia (hemoglobin below 7 g/dL) with ongoing hemorrhage require intravenous conjugated estrogen 25 mg every 4 to 6 hours until bleeding slows, then transition to combined oral contraceptives with iron support. Tranexamic acid or low-dose regimens suit mild cases with hemoglobin above 10 g/dL. Progestogen-only therapy alone controls bleeding less reliably in this setting. Her tachycardia and orthostatic symptoms place her in the severe category despite preserved blood pressure.

Reference: DC Dutta's Textbook of Gynecology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.