Most stable patients can be discharged home with timely gynaecology outpatient follow up.13,22 Unstable patients and those with significant anaemia may require admission for transfusion and urgent gynaecological inpatient assessment.4

Diagnosis Management and Disposition
Adenomyosis First line treatment is with LIUS.6 Second line is with any of TXA, NSAIDs, oral contraceptives.8Definitive treatment is with hysterectomy.
Leiomyoma <3cm – First line treatment is with LIUS.8 Second line is with any of TXA, NSAIDs, oral contraceptives.8
>3cm – Requires referral to gynaecology OPD. TXA/NSAIDs can be used while awaiting investigations and definitive treatment.
Malignancy All suspected malignancy should be referred urgently to gynaecology outpatients on a 2 week wait pathway where available.
Coagulopathy May require both gynaecology and haematology input for specific treatment. Options include hormonal treatments as above, desmopressin and TXA.6
Ovarian dysfunction Medical treatment may be effective but may need referral to gynaecology/endocrinology.4
Iatrogenic It may not be appropriate to stop the offending drug, particularly in ED. Bleeding may be managed medically depending on the cause.
Ovarian torsion Urgent gynaecological referral with a view to emergency surgery.
Foreign body Remove FB if possible, otherwise referral to gynaecology. Antibiotics may be required if signs of infection present.
Trauma Referral to gynaecology for significant trauma. Involve the appropriate authorities if suspected rape, sexual assault, domestic violence.
PID BASHH antibiotic regime: IM Ceftriaxone 1000mg stat, PO doxycycline 100mg BD for 14 days, PO metronidazole 400mg BD for 14 days.If unwell admission is advised for IV antibiotics e.g. fever, tubo-ovarian abscess, pelvic peritonism, etc.
Source of bleeding other than genital tract Treat the underlying cause e.g. UTI/haemorrhoids/rectal tumour.