Physicians' Perceptions of Intravenous Estrogen for the Management of Acute Abnormal Uterine Bleeding

Background  Acute abnormal uterine bleeding (AUB) is a common gynecologic complaint for which patients seek treatment. While many reasonable options exist for the management of AUB, the only Food and Drug Administration (FDA)-approved treatment option for acute AUB is intravenous (IV) conjugated estrogen. Our study aimed to investigate physicians' preferences for the management options of acute AUB and specifically examine their opinions regarding IV estrogen.  Methods  We created an electronic survey that was emailed to Obstetrics & Gynecology (OBGYN), Emergency Medicine (EM), and Internal Medicine (IM) physicians. Responses to the study were analyzed. Frequencies and percentages were reported to summarize survey responses. Cumulative or ordinal logistic regression models were used to estimate the effects of predictors on the odds of a higher likelihood or preference for prescribing IV estrogen for acute AUB.  Results  A total of 39 physicians responded to the survey. Only 6 (15.38%) indicated IV estrogen as their first-line choice for management of acute AUB. Only 13 participants (33.33%) indicated that they were comfortable prescribing IV estrogen. The most common indication for not prescribing IV estrogen was being unfamiliar with the typical regimen (18/26, 69.23%). Overall, OBGYN resident physicians were the most likely to feel comfortable prescribing IV estrogen.  Conclusions  Only a little over half of all participants correctly identified IV estrogen as being FDA-approved for the management of acute AUB. Approximately one-third of participants indicated that they were comfortable prescribing IV estrogen, while a near majority of participants indicated they were unfamiliar with the typical regimen. Future direction should include multidisciplinary educational initiatives regarding the management of patients with acute AUB.