Inpatients with menometrorrhagia: etiologies, treatments, and outcomes

Abnormal uterine bleeding is commonly seen in emergency departments and gynecologic clinics. In a southern, inner-city hospital, a seemingly large number of women are admitted with life-threatening anemia of benign gynecologic origin. We examine its causes, review treatments and outcomes, and discuss optimization of therapy.

A chart review of patients requiring emergency admission for anemia of gynecologic origin yielded 48 patients from July 1, 1994, through April 30, 1998. Patients with known or obvious gynecologic malignancies were excluded.

Of 48 patients, 69% were black. Mean age was 41 years. Sixty-three percent had had no previous treatment. Almost one fourth had a history of mental illness and/or substance abuse. Two thirds had uterine leiomyomata. Most (81%) required transfusion; 25% had surgery during initial hospitalization. Of those who did not receive definitive therapy (hysterectomy), 13% were subsequently readmitted for active bleeding and/or symptomatic anemia.

Our study patients were admitted with potentially life-threatening anemia. All were adequately resuscitated using a variety of measures, including high-dose estrogen therapy and transfusion. Optimal therapy for those requiring emergency treatment should include hormonal therapy and transfusion if necessary, early surgical intervention unless otherwise contraindicated, and close follow-up until definitive therapy is achieved.