Hey what's going on guys and welcome to episode 86 of the physician

assistant boards dot-com podcast today we're going to be answering a question from a

student I received his email today and I thought this would be a good question to

answer for everybody else out there

and it has to do with dysfunction uterine bleeding and enses and so why enses are actually

indicated or why they can be used in the management of abnormal uterine

bleeding. So here's this question. I was reading over dysfunction uterine

bleeding on the phone out this morning and saw that treatment involves OCPs and Nseds. I'm confused with the

Nseds aspect because I would think that these would cause increased bleeding

due to their Cox 2 inhibition. Can you shed some light on this information if the mechanism is known? Thanks.

So before we get into Ensets, let's go over First Line Treatment because you have to keep in mind

and sets are not as effective as other options right they're an option if for

whatever reason other options are contraindicated or if they cannot be used. So let's get into first line treatments here.

Now we're going to be discussing abnormal uterine bleeding, but we're not going to be discussing

hemorrhage or prolonged uterine bleeding.

Really the way we're going to treat really heavy prolonged uterine

bleeding is going to be with high-dose estrogen. That's really going to be first

line. We can use premrin or we can even use oral contraceptive pills and dose

them in a higher frequency. So for example when I have a patient that comes in with

heavy bleeding they're clotting it's been 10 days 11 days 12 days then you can

typically control the bleeding with high-dose oral contraceptive pills with estrogen.

So you're going to use a pill that has about 35 micrograms and you could dose this 3 to 4 times a day for the first couple of days.

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