1. Not believing the patient – if she says the bleeding is heavy and it is impacting her life then she meets criteria for HMB.
  2. Failing to recognise red flag symptoms of malignancy such as postmenopausal bleeding.
  3. Failing to recognise that the bleeding is from another source e.g. rectum.
  4. Not examining the patient fully and missing obvious clinical diagnoses e.g., PID, foreign body.
  5. Not checking a hCG because the patient says there is no way she could be pregnant! Check a hCG… EVERY TIME!
  6. Waiting for a urine sample to test for hCG in an unstable patient. Use whole blood on the point of care pregnancy test while awaiting a formal serum hCG.
  7. Requesting a pelvic ultrasound on all patients. In most cases this will not change your ED management and is not necessary.
  8. Not being familiar enough with the various treatments to discuss them with the patient.
  9. Failing to recognise signs of trauma and therefore missing an opportunity to intervene for a vulnerable patient.
  10. Failing to treat anaemia caused by the heavy menstrual bleeding.
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