Rosh Emergency Medicine Practice Test

In managing a patient with heavy vaginal bleeding and an enlarged, tender uterus, which therapy is most appropriate?

1. Conjugated estrogen

2. Intrauterine balloon

3. Oxytocin

4. Uterine artery embolization

The correct answer is: Conjugated estrogen

In the scenario of heavy vaginal bleeding accompanied by an enlarged, tender uterus, the most appropriate therapy is conjugated estrogen. The use of conjugated estrogen is particularly relevant in cases of bleeding due to uterine atony or pelvic organ conditions such as fibroids or adenomyosis, especially in premenopausal or perimenopausal women. Estrogen promotes endometrial stabilization and proliferation, which can help reduce excessive bleeding. This option is critical in addressing the underlying hormonal imbalance that could be contributing to the bleeding episode. It acts quickly to reduce uterine bleeding by enhancing the clotting factors and promoting the repair of the endometrial lining, which is essential in this context. While intrauterine balloon placement can be an effective intervention for controlling uterine bleeding by providing physical pressure on the endometrium, it is often more suitable for cases related to retained products of conception or post-delivery complications rather than primary management of heavy bleeding with an enlarged uterus. Oxytocin is primarily effective in stimulating uterine contractions and is often used in the context of postpartum hemorrhage, but in the case of an enlarged, tender uterus indicative of possible underlying issues, estrogen is more appropriate for immediate management. Uterine artery embolization is usually reserved for