Pitfalls
- Not believing the patient – if she says the bleeding is heavy and it is impacting her life then she meets criteria for HMB.
- Failing to recognise red flag symptoms of malignancy such as postmenopausal bleeding.
- Failing to recognise that the bleeding is from another source e.g. rectum.
- Not examining the patient fully and missing obvious clinical diagnoses e.g., PID, foreign body.
- Not checking a hCG because the patient says there is no way she could be pregnant! Check a hCG… EVERY TIME!
- 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.
- Requesting a pelvic ultrasound on all patients. In most cases this will not change your ED management and is not necessary.
- Not being familiar enough with the various treatments to discuss them with the patient.
- Failing to recognise signs of trauma and therefore missing an opportunity to intervene for a vulnerable patient.
- Failing to treat anaemia caused by the heavy menstrual bleeding.
