Heavy menstrual bleeding (HMB), a subtype of abnormal uterine bleeding (AUB), is a common complaint among adolescents and young adults, affecting as many as 34%-37% of the population at any given time1 and is further characterized as either acute or chronic. The Federation of International Gynecology and Obstetrics defines acute AUB as an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss.2 Acute AUB may require hospitalization and blood transfusion for those with potentially life-threatening anemia. Treatment regimens for acute AUB generally consist of hormonal medications.1 Though intravenous conjugated equine estrogen (IV-CEE) is the only hormonal medication approved by the U.S. Food and Drug Administration for the treatment of acute AUB,3 other commonly used medications for the rapid cessation of uterine bleeding include combined estrogen-progestin oral contraceptive pills (OCPs),1 oral progestins,4 and a combination of oral and intramuscular progestins.5 Treatment choices differ greatly by specialty6 and though treatment algorithms have been published, they are based on expert opinion rather than clinical trials.7

Despite the many medical options for treatment of acute AUB, there are very few studies comparing them. The only comparative trial of IV-CEE in the management of acute AUB was one that compared it to placebo in adult women presenting to the emergency room, a study that is now over 40 years old.8 There are no published studies examining time to cessation of bleeding or length of hospital stay (LOHS) in hospitalized adolescents with acute AUB. Algorithms for the treatment of acute AUB have been developed within institutions and some have been published,7 but they are all based on expert opinion rather than clinical trials.7 Many of these recommend that IV-CEE be used as first-line treatment for patients with severe anemia or have failed outpatient treatment.1,6,7,9., 10., 11. Based on this recommendation, one may assume that IV-CEE leads to faster cessation of bleeding and therefore, shorter LOHS for patients hospitalized for acute AUB compared to other hormonal options, but there is no evidence to suggest this. The goal of this study is to address this paucity of data, by assessing outcomes of adolescents admitted for the management of acute AUB and severe anemia treated with high-dose OCPs (HD-OCPs) alone vs HD-OCPs plus at least one dose of IV-CEE (referred to in this study as dual therapy), two frequently used treatment regimens at our institution. This study aims to determine if LOHS was significantly affected by the addition of at least one dose of IV-CEE to a patient's treatment regimen. Additional outcomes included complication rates and side effects secondary to medications administered.